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!

Rotation 7: Oral Oncology (Ambulatory Care)

Posted by Unknown at Saturday, February 16, 2019

Over the last 6 weeks I had the opportunity to experience a new (to me) kind of Ambulatory Care clinic. I worked with the Oral Oncology team to follow-up with people who were on oral medications for their cancer.

This was a phone-based clinic where we did initial, 10 day follow-up, and 6 month follow-up calls. Initial calls included medication counseling on how to take the medication, possible side effects and how to manage the side effects. We followed up with these patients after they had been taking the medication for about 10 days (and then 6 months) to see how they were doing.

This rotation required critical thinking and problem solving as each patient case was different and needed to be examined in order to know the appropriate time to contact the patient. Follow-up calls also needed to be handled differently in terms of setting up additional follow-up by the team or by clinic.

I also had the opportunity to be in the Genitourinary cancer clinic one half-day a week. This was the first time I experienced an ambulatory care clinic where the pharmacist did not have a set schedule of patients to see during the day. The pharmacist would use a custom scoring tool in order to decide which of the physician's patients she was going to see that day. When she went and saw patients she did a lot of symptom management and medication counseling. She was also available for questions from the nurses and physicians. Being in the GU clinic helped break up my Monday's, but it also allowed me to see a different format of ambulatory care clinics; and for that I am very thankful.

One of the best things about this rotation was the people! I got to work with multiple pharmacists, residents and pharmacy students who were extremely passionate about the work we were doing as well as extremely knowledgeable about the subject.

As I finish this rotation and move on to the next I am taking with me a greater confidence and ability to counsel patients, communicate empathy and adapt to different situations quickly.

As a follow-up to my last post I also wanted to talk briefly about this last rotation in terms of residency interviews. This rotation was 6 weeks long (1 week longer than the others) to allow for students to miss up to 5 days for interviews. I am very thankful that I was able to finish all of my residency interviews during the 5 days this rotation. Now all I have to do is rank the programs and wait until March 15th!

Rotation 7 - General Medicine and Residency Interview Season

Posted by Jared at Thursday, February 16, 2017

Hello everyone! January and the first part of February have been a pretty busy time, but I'll update you with my latest rotation, along with my insights on residency interviews after going through the process!

Rotation 7: General Medicine

Like Millie, I was assigned to cover an adult internal medicine service for my general medicine rotation. During this rotation, you have the option of ranking between adult internal medicine, cardiology, surgery, pediatrics, or the NICU. Note that the NICU is typically an afternoon rotation, while the rest run from a normal 7-3:30 schedule. There are some blocks where the ED is an option for this rotation, but it wasn't during this block. Millie describes the rotation pretty well, but I'll quickly go over my time frame during the day.

6:00 - 7:00 AM: I would arrive at the hospital to work up patients for my service. On average, it would be about 10-12 patients a day.

7:00 - 8:15 AM: Talk over the patients with the resident I was on rotation with first, make
recommendations, then go over those recommendations with our main preceptor prior to rounds

8:15 - 11:00 AM: Round with the medical team

11:00 - 12:00 PM: Go over patients, discuss status/interventions, topic discussion

12:00 - 2:00 PM: Lunch, attend educational lectures (i.e. CE, resident on-call report), look up drug information questions, write warfarin/vancomycin notes, follow up on other medical issues for the team.
2:00 - 2:30 PM: Follow up with preceptor on issues, mini-topic discussion

2:30 - 3:30 PM: Student topic discussion. These consisted of either general topic discussions from preceptors, or student-led discussions that included new drug presentations, a topic discussion, journal club, and case presentation.

I enjoyed having internal medicine as my past rotations (ID and critical care), I felt I was only looking at certain aspects of the patient (i.e. antibiotics, renal dosing, etc.). However, on internal medicine, I could no longer ignore all the comorbidities a patient had. I really needed to make sure that a patient's medication was correct for not just the main problem, but even their home meds as well. It really taught me to look at the patient as a whole, and definitely helped solidify my knowledge. Also, my preceptor was great at going over a bunch of topics that helped me revisit a lot of areas from therapeutics. This definitely helped me out for residency interviews, which I'll go into next...

Residency Interviews

The month of December after Midyear is a frenzy. You're choosing where to apply, you're getting your letter of recommendations in order, and you're stressing out waiting to see the e-mail confirmation that they've been sent to PhORCAS, and that your transcripts are in. You spend days writing a letter of intent, and then you hit submit and play the waiting game.

Programs go about offering interviews very differently. There's no standard set of rules in terms of when they respond or how they will respond. Some programs will tell you when they'll get back to you by, others will just be silent until they send an interview offer or rejection. Some of my programs responded pretty quickly after the deadline, others took a few weeks. Some programs will either only give you one date to interview, some will have you fill out a list of preferences, or some will give you dates and you simply choose the one that works for your schedule. Finally, some programs will e-mail you, and some will call.

This process honestly requires you to both be extremely flexible and to have your calendar and phone at the ready. This is particularly true when some programs will call you and ask you to interview on a date, and you have to pick on the spot. Thankfully, I was able to have an hour or so to look at my calendar before responding back to them after the phone call, but I know of some students that weren't afforded that luxury for some of their programs. Sometimes, however, you will run into scheduling conflicts with interview dates if a program only offers certain dates or if you have rotation requirements. If you're unable to re-schedule the interview and can't accommodate it into your schedule for whatever reason, it's okay to decline as long you as explain your rationale and express your gratitude for being offered the interview in the first place. Programs would prefer you cancel prior to scheduling a spot. DO NOT schedule an interview and then cancel last minute. This causes bridges to be burned and looks extremely unprofessional on your part, and since pharmacy's a small world, you never know who they might tell...

As for the interview process, I would say Michigan prepares us extremely well. Most questions weren't out of the ordinary in terms of questions you would expect (why residency, why our institution, situational questions, tell me about a time when..., etc). At this point in time, I have completed the majority of my interviews, with just one more between now and when our rank list is due for the Match. Some tips I have below based on my experience:

• Know your CV inside and out, forwards and backwards. I studied my CV prior to interviews and took notes on all my presentations in case I got asked about any of them. The rule of "if it's on your CV, it's fair game" is extremely prevalent during residency interviews. Looking back, I've been asked about the majority of my presentations/projects, or have at least referred to them at one point during the interview process. It doesn't look good if you can't speak to at least what the project/presentation was about and what you did. For Michigan students, this is EXTREMELY true for your PDI. PDI becomes a default answer to a lot of questions (tell me about what you're most proud of, a time when you had to manage multiple deadlines, etc). Know your PDI, what you did, and what it found. I know I have been asked about it on multiple interviews.
• Try to group interviews together that are geographically close, especially if you know their dates ahead of time. This particularly applies to applicants going out of state for interviews. For example, I had some interviews out in the Pacific Northwest that I was thankfully able to coordinate in the same week, so I didn't have to travel back and forth between Michigan and Portland/Seattle. Some programs do release their interview dates ahead of time, so you can try and be strategic about choosing dates.
• Be nice to everyone you meet, including your fellow interviewees! The adage "you're being evaluated the whole time" honestly holds true. I had heard that programs evaluated how social you were with the other candidates you interviewed with, so this is something you want to keep in mind. While you're all interviewing for the same spot, note that these people could potentially be your co-residents! You don't want to appear stand-offish or anti-social, as program directors and preceptors will notice. 
• Eat breakfast and drink coffee/water if you need it! Interviews are a long day, and there are a lot of people you're going to be talking to. Make sure you're fully energized for the day, so your brain is at its sharpest.
• Be prepared for clinical cases. A number of programs have parts of the interview where you have to work through/present a clinical case. From my personal experience, I've experienced a lot of ID/anticoag, but generally a lot of these cases are types of situations you might experience on an internal medicine rotation. The main thing interviewers are assessing here is your thought process. Don't stress too much if you don't remember the exact dose of azithromycin you'd give for a patient with CAP or how long you would treat them. One thing to mention always is where you might go to look up that information (i.e. IDSA guidelines, institutional guidelines, etc.)
• Write down your interventions/disagreements as you go through your APPEs. You'll almost always get asked about your most meaningful clinical intervention, or about a time a doctor disagreed with you. Writing these down will help you to refer to it later during interviews.
• Remember you're interviewing them, too. Just getting to the interview is an accomplishment, especially with how competitive residencies are now. Honestly, just be yourself and try to get to know them, along with showing off your personality. You really want to know if you'll "fit" at the program, as you'll be spending the next 1-2 years there, and you don't want to hate your time there and be miserable. As always, prepare a number of questions for the different people you might meet (i.e. residency program director, preceptors, coordinators, residents). Finally, don't feel bad asking multiple people the same question. It's good to get different perspectives to help you better assess if the program is a fit for you.

I will say doing most of my interviews during the general medicine rotation was mildly hectic, but I'm glad most of them happened during this block. I felt really prepared for the clinical cases I came across and had various things I could speak to when interviewers asked me about clinical interventions/disagreements. Thankfully, I had most of my interviews during this block, as I'm currently in DC doing a rotation at the FDA. However, note that there are a lot of interview dates that occur during block 8, where you don't have an extra 5-6 days built in to go on interviews. Thankfully, my preceptors during both rotations have been really accommodating with me and have allowed me to go on interviews.

Hope that helps with a picture of residency interviews or the general medicine rotation. Feel free to e-mail me (jpborlag@med.umich.edu) with any questions. Thanks!

Rolling in the Deep: Preparing for Life Beyond Rotations

Posted by Adam Loyson at Sunday, April 06, 2014

I hope everyone has been staying warm these past few winter months and ready for spring! Since last writing about my rotation with the U.S. Indian Health Service, I find my rotation experience taking a twist. I am currently in the pediatric emergency department, preparing applications for postgraduate opportunities and beefing up my interviewing skills. As an attendee of the recent American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting, I’d like to share my tips to help those who are pursuing residencies and fellowships and planning to attend next year’s meeting. For those with postgraduate training, entry-level job, and summer internship interviews looming on the horizon, I also provide valuable advice on networking skills and how to prepare for an interview.

Successful networking

   As a student pharmacist looking into nontraditional career paths, I found great networking communication skills a cornerstone for discovering unique opportunities and resources. The primary tool I used when reaching out to individuals outside of the college and at ASHP Midyear was my elevator speech as a personal introduction. I found that creating a 30-second summary of who I am, what I can contribute, why I wanted the position, and my future goals, was a very time-effective way to share my interests with others. It also gave those listening a helpful backdrop for providing advice. After creating an elevator speech, practicing with my pharmacy preceptors was a great way to receive valuable feedback and perfect my initial presentation. 

You’ve introduced yourself using an elevator speech; now what? I preplan my conversations by researching the individual’s background and outlining specific points I want to cover. After an elevator speech, I remember to keep the person I am talking with engaged in genuine conversation to show that I care about what he or she is saying. I do this by making good eye contact, using professional language, and periodically confirming I am listening by asking thoughtful questions. At the end of the conversation, I offer to exchange business cards for follow-up later. I receive the person’s business card with both hands and express my gratitude. This act displays respect, since in some cultures business cards serve as an extended representation of the person.

ASHP Midyear

    The networking skills I described above definitely helped me out at ASHP Midyear. At a conference where more than 20,000 attendees from more than 80 countries are competing to talk with representatives of postgraduate programs, every second of communication counts. Whether you attend the residency showcase, interview through the Personal Placement Service for residencies and fellowships, or seek entry-level positions at the exposition, the single most important thing is being prepared.  

Research the programs you are most interested in, find out where and when the program representatives will be available to talk to interested students, and bring a few copies of your updated CV. Don’t forget to dress business professional and prepare a few intelligent questions to ask of your own. Remember, you are also trying to find out if they will be a good fit for you.

Preparing to interview

    The key to getting an interview is an excellent CV. However, after you get the interview invitation, what do you do? My best advice is to be prepared (sense a theme?), be on time, and be professional. Based on my own experience, I can tell you that practice makes perfect. During an interview, demonstrate your interest in the position, show enthusiasm, be confident, and relax. Be yourself—the interviewers just want to get to know you better. Searching online for commonly asked interview questions beforehand can give you a feel for what to expect. If behavioral interview questions are asked, my recommendation is to answer using the STAR approach: describe the Situation, the Task, the Action, and the Result. After the interview, don’t forget to follow up by acknowledging your appreciation, your interest in the position, and reaffirming your qualifications with your interviewer. 

The next step

    Following the nontraditional pharmacy career pathway, I am seeking positions within the U.S. Public Health Service after graduation. After reaching out to individuals at FDA and Bureau of Prisons, reflecting on completed rotation experiences, and reviewing past shadowing opportunities, I have decided to apply for entry-level positions within both agencies. As future interviews approach, I will be following my own advice and hope my recommendations are useful for you as well.

Another post about residency?!

Posted by Anna at Sunday, April 14, 2013

Yes, this is another post about residency. If you are so over it already, I completely understand—feel free to move on to the next post. I will say that Kristen posted a recent entry with a lot of great information and tips based on her experiences, and I highly recommend checking it out for a complete overview and residency how-to. Instead of rehashing that information, I wanted to reflect on just a few points that may be relevant to those who find themselves in my shoes.

Specifically, this could be meaningful to you if you are….

• A P4 student seeking PGY-1 hospital-based residency
• Planning to enter practice as generalist after completion of a residency, but open to further specialization via PGY-2 if you happen to find something that truly grabs you
• Restricting your search to Southeast Michigan based on a significant other or for other equally valid reasons

For the benefit of this post (and just for funsies), I have decided to interview myself:

Q: Why complete a residency if you want to pursue a generalist position? Do you even need a residency for that?!

A: You do not need a residency for a generalist position, and many people start in a generalist position immediately after graduation. Residency is a very personal decision and is not the right path for everyone—do not feel like you have to do one! For me, I wanted the extra year of hospital-based rotations, intensive study, and freedom to learn underneath an experienced pharmacist to either become a stronger and more confident generalist or to determine if further specialization is the path I want to pursue. I was also very open with my reasons for residency through my letter of intent and during my interviews.

Q: If I want to stay in Southeast Michigan, do I have to go to Midyear?

A: Absolutely not. The SE Michigan Residency Showcase and Career Gateway events both occur in mid-October to early-November, and are great venues to learn about the local residency programs. Unfortunately, I was not able to attend these events due to being out of the area on rotation. I did go to Midyear primarily to present a poster on my PharmD research, and I was able to chat with Michigan programs at the residency showcase there. If you do end up attending Midyear, do not feel bad speaking to Michigan programs! The only one I would stay away from is UofM, strictly because if you are a UofM student you will have easy access to resources regarding the program back in Ann Arbor.

Q: How many programs did you apply to and how did you choose?

A: I ended up applying to seven programs. Knowing you want a SE Michigan residency really helps narrow down the initial list of possible programs, but still leaves you with a considerable list. With my personal goals, I wanted a program that had teaching opportunities, diverse rotation opportunities, a bigger residency class, and a large health system. I was able to narrow down my list to seven programs—which is still sort of a lot until you realize that Detroit Medical Center requires separate applications for each site—through information on websites as well as what I gathered at Midyear. I accepted interviews at all seven sites, as I wanted to physically visit the hospitals and experience the learning environment. I do believe that you get a definite feel for each residency once you actually interview, and this feeling played a big role when I ranked my programs. Additionally, since I was within a 40-50 minute drive from each interview, it was feasible for me to go to many interviews without spending money on flights, hotels, and other travel expenses.

Initially I was jealous of my classmates who had the freedom to apply to any program in the nation, with no geographic limitations. However, I found that Michigan has many amazing residency opportunities, and I did not have to compromise any of my “must haves” in a program in order to stay in the area. Hopefully these few points will be helpful to those who find themselves in similar situations, and good luck!

What to Do, What to Do

Posted by Matthew Lewis at Sunday, April 08, 2012

My scramble at one site did not do well. We just weren't a good match. I wanted something to prepare me for a PGY2 in solid organ transplant, and they just couldn't provide that and didn't feel comfortable trying to shoehorn me in. Oh well, now I must begin the exciting process of finding a job. This job hunt will not be like any other. This time around, I might be employed with the company for years, even decades, whatever and wherever I decide. The possibilities are limitless, and for that reason it is empowering, yet overwhelming. There is still a chance at a second scramble site, and from what I know, I am one of the few P4s still scrambling.

Speaking of overwhelming, when you thought you would do a residency, but find out that isn't an option, it is overwhelming. You go into the match having made careful plans, the investment of hundreds, if not thousands of dollars, and the full backing of those who wrote your letters of recommendation as well as your other mentors. Then you find out something didn't go right. It's crushing. You will re-evaluate why you ever went into pharmacy. You will try to find some fault in yourself or your education, anything at all, but sometimes for whatever reason things just don't go your way. It is okay. You just have to find another path. Two of the most successful people in the class of 2011 didn't match, and are currently employed in jobs they would not leave for any residency. A few scrambled successfully and are enjoying themselves as well.

To anybody considering a residency, make sure it is something you really want to do. Ask yourself if there will be positions out there once you've completed the residency, and ask yourself if those positions absolutely require the completion of a residency. After Midyear, start working on your applications but take your plan to one of our faculty, like Dean Mueller or Dr. Kraft. Our faculty is very approachable and incredibly connected. They can let you know what they think of your plan and how to make it better. Our faculty wants to see their students succeed. In hindsight, I should have done this, but you learn from experience.

Things will work out for me even if scramble site 2 doesn't work. I still will be graduating from U of M, and I still have all those people I networked with while applying for residencies and going through my rotations this year. I have my drug knowledge, which will be tested and cleared for practice in just a few short months. There are plenty of other things I still have which haven't changed.

I do hope this post will help some of you in the future find your path to a residency. I also hope that this post will serve as kind words in a troubled time for those who didn't match in the future. It just seemed fitting that this post be made on Easter, where many people celebrate the concepts of rebirth and transformation. Happy Easter, everyone!

Note: This was edited by myself to clarify events to paint a more accurate picture of the scramble.

February Rotation + Residency Interviews

Posted by Elizabeth Kelly at Thursday, February 16, 2012

Well, I am one of those select few that chose to keep my February rotation in place and go through residency interviews. Do I regret it... kind of but not really. I am going on a cruise to the Bahamas next month with my best friend during her spring break from Western, so I am pretty stoked to have March off.
Anyways... I am on my Quality and Medication Safety rotation with Paru Patel who is the Associate Vice President at Sinai Grace.
What is majorly cool about this rotation... I have my own HUGE office, with a HUGE desk and computer. And a secretary outside the room who is SUPER nice. And 2 doors down from the President's office (they had one of their executives leave for a year to go to Afghanistan so his office is empty).
I do a lot of work as well... right now I am putting together the process for first fill patients through the outpatient pharmacy at Sinai Grace and evaluating the number of patients in the hospital who get first fill and are rehospitalized. Note... rehospitalizations are a HUGE deal in hospitals right now with the new CMS standards that are being implemented starting this fall.
I am also putting together Executive Safety WalkRounds with the executive team here at Sinai Grace in order to cut down on safety issues in the hospital and make it a better more cohesive environment.
Now mixing all this with residency interviews has not been the greatest. I have had to take 5 days off and done a lot of work at home. I am potentially making those days up the first few days of the March rotation block. We will see... hopefully I can get all my work done ahead of time!
I would recommend if you are going to have a rotation and apply for residencies during February then make sure its a low key rotation where you can potentially get a lot of work done at home to make up for missed time.
Recommendation: Sinai Grace is a really fun environment and I highly recommend having a rotation there!! And Dr. Patel is great and really cares about the students she has on rotation and makes sure I have a great all around experience.

ReSiDeNcY - Follow-up

Posted by Melanie at Thursday, February 09, 2012

Great Advice, Jenna!

I think this brings me to another point - depending on who you ask for advice, you may get varying answers. For example, when you put together your CV, some preceptors will tell you they like you to provide a little blurb about what you did on that rotation, while others will tell you not to put that information on there.

Conflicting advice does not necessarily mean someone is wrong because it may just be preference. If you use your own judgement and common sense, you can usually come up with a solution that best fits your style.

As you can see, Jenna and I already did things a little bit differently but we both received all but one interview from our programs.

Let the Games Begin!!

Posted by Jenna at Tuesday, February 07, 2012

Interview season is in full force and it's going to be a fun-filled but bumpy ride! While some of my classmates have had quite a few interviews already, I'm just preparing for interview #3. It seems that a lot of the in-state, Michigan, programs had early interviews, starting a little over 3 weeks ago now.
I thought that I'd add to Melanie's great advice because you can never have too much advice during this crazy part of your life:

#1. As soon as you know where you're applying, give the people writing your letters of recommendation their materials. I put together a word document that listed each program, in order of due date. I wrote out the addresses on each envelope, stamped them, and included any supplemental papers, if required, in the envelope. While my deadlines ranged from Dec 31-Jan 15, I asked that my letters be mailed by Dec 20th, if possible. My preceptors already had their letters written for the most part (I asked one in August, one in October, and one in early November). Ask your preceptors to let you know when they sent their letters and follow-up with them if it's a day or two before 'your' deadline. Give your preceptors plenty of time. Give them everything they need, in an organized, ready-to-mail fashion. Ask that they let you know when letters have been sent. Don't bug them! Follow up with hand-written thank you notes.


#2. I sent all of my applications via the USPS. I sent them priority mail (~2 day delivery) with delivery confirmation, which cost $6 each. I sent half of them out before Christmas and the other half (which had supplemental parts) out right after Christmas. I sent everything together in one big envelope so I didn't have to keep track of individual pieces of mail getting to the program.


#3. My first interview offer came on 1/6 and my last on 1/26. You may get different advice but I would not recommend emailing RPD's (residency program directors) to ask if they've received your application. 12/13 of the programs I applied to sent me a confirmation email that all of my materials had been received. This is a busy time for RPD's and I think some could find it annoying if you're checking in on them. If you get delivery confirmation when you mail it, you know they have your stuff.


#4. Once you start hearing back from programs, scheduling interviews becomes quite the work of art. Keep your calendar with you at all times because you never know when you might get a phone call or email with the next interview offer! Some programs give you dates based on 1st come, 1st serve. I was lucky in that my January rotation I worked from home, so I was able to respond to emails quickly and answer my phone when calls came through. My biggest word of advice: don't schedule any flights until you've heard from all of your programs!!! I wasted a good chunk of change calling and changing flights so that I could fly from one city to the next, rather than flying back to Detroit in between. That's the only way to fit in as many interviews as you can.


#5. Prepare for interviews but know that you can't prepare for everything. I've actually shocked myself at how 'little' I've prepared for interviews, compared to how 'on top' of things I usually am.  I think part of that has to do with the fact that I want to be myself, so programs get to know me, not someone I'm trying to make myself out to be. I think it's important to have points in mind that you want to cover for some of the 'popular' questions but you don't want to sound like a recorder. Questions you must be ready to answer
-Tell me about yourself (i.e. elevator speech)
-Why do you want to do a residency?
-What are your short/long term goals?
-Tell me about your rotations and what you did on them.
-Why do you want to do a residency here?
-What are your strengths/weaknesses and how will that help/hinder you during residency?
-Tell me about a recommendation that you made that improved a patient's care.
-Tell me about a recommendation that you made that wasn't accepted and how did you handle it?
-What do you like to do in your free time?


#6. Have A LOT of questions ready to ask. You should be interviewing the program as much as they're interviewing you. You need to make sure that it's a good fit for you - a year is a long time to be miserable! The amount of time I've had to ask questions has been quite surprising to me so it's important that you can fill that time with intelligent, thoughtful questions. You will look like a doofus if you don't have questions and will just lead to either an awkward silence or your interviewers trying to come up with more questions to ask you. It's okay to repeat questions when you're with different interviewers, it's good to get multiple opinions.


#7. Write hand-written thank you notes to the RPD and pharmacy director(s) (if you interview with them). I also wrote thank you's to all of the residents but most of my programs only had 1-2 residents. Some people may recommend writing hand-written notes to every person that interviewed you but unless you have an abundant amount of free-time and unlimited stock in stamps, I would say this isn't necessary. If there's someone that went out of their way to make your experience extra pleasant or if you spent an extended amount of time with an interviewer, then by all means, write them a nice hand-written letter!


#8. There are a wide variety of interview formats. Some interviews will pretty much be straight Q & A/drilling all day with an opportunity to eat lunch/talk with the residents. This is probably the typical interview format, which seems 'all about them.' Some interviews will have some 'drilling' and may also include a patient case to work-up & present or a 15-30 minute presentation that you have to give. Other interviews will be much more 'relaxed,' and to me, seem much more about giving you the chance to figure out whether their program/institution is right for you. As an interviewee, I very much appreciate the last scenario. The interviews/places that I loved were the places where I got to attend rounds, tour pretty much the entire hospital, have sufficient time to talk with the current residents, and have had ample amount of time to ask questions of the RPD/preceptors. 

ReSiDeNcY !

Posted by Melanie at Friday, February 03, 2012

This post highlights some of my experiences in the residency process thus far...........

1 -- What month to take OFF -- If you are considering pursuing a residency and plan on applying and interviewing at more than a couple of places, I HIGHLY suggest you take the month of February as your OFF month. Yes, having the month of December off so you can go to Midyear and enjoy the holidays sounds enticing, BUT the month of February is very stressful and you will have enough to worry about rather than trying to balance interviews and the requirements of a rotation and making up time you had to take off for interviews.

Having the month of February off has allowed me to spend time preparing for my interviews. I am able to spend adequate time reviewing programs, practicing interview questions, and preparing questions for the programs. It has also allowed me to have extra travel time -- I am only applying in Michigan but some places are still quite a hike from Ann Arbor, especially if you have to arrive to your interview by 8AM and it is a 2-3 hour trip, you might want to travel the day before and spend the night at a hotel. That being said, if you are applying around the country you need to be able to have time to fly out there and back.

2 -- Midyear -- I did not go to Midyear and I have secured five interviews. Keep in mind -- I am only pursuing residencies in the state of Michigan. I certainly DO NOT discourage anyone from attending Midyear as it is a great opportunity to network with people from other schools and gain experience with talking to people about their programs and what they have to offer -- AND there is the chance to discover a residency that might be perfect for you that you were not even aware of. However, if you feel like you are in the same boat as me and you are debating about whether you should go or not, have peace of mind knowing that you can still get interview offers.

That being said -- Instead of going to Midyear I networked with the institutions I was interested in using other means. 1 -- I went to the SMSHP Residency Showcase; 2-- I attended career gateway; 3 -- I contacted current residents or residency directors with questions that I had; 4 -- I explored websites for programs that had them available.

3-- Narrowing it down -- Because I knew I was not going to Midyear, I was able to take my list of programs that I had explored and narrow it down after Career Gateway. For those of you who go to Midyear, narrow your list down as soon as you get back, keeping in mind the deadline for some programs is the end of December.

I had a list of 13 programs I was interested in and narrowed it down to 6. How did I narrow it down? I had a list of criteria I was looking for - some of mine included a teaching component, a management rotation option, and a positive interaction with a program director or past/current resident. When it came down to it, only 6 of the programs had everything I was looking for in a PGY1 residency program.

4 -- Letters of Support -- Once I had my six programs picked out, I immediately notified my letters of support writers to inform them that I had picked out the institutions I was applying to. I gave them the deadlines for each institution and asked if they would be able to meet these deadlines. I am glad I did this because one of mine was unable to provide the letters in time. After I had received confirmation from the people who agreed to write my letters, I put together pre-addressed envelopes with stamps on them, printed off any forms that needed to be filled out, printed out instructions for how to complete each letter, and printed a copy of my CV. I gave each letter of support writer a packet with their information in person and also provided electronic copies of the forms, instructions, and my CV.

About 2.5 weeks prior to the first deadline, I sent an email out to each writer reminding them of the deadlines for each program.

5 -- TRANSCRIPTS -- For my U of M transcripts I went online and ordered transcripts to be sent right away to all of the programs AND another set of transcripts to be mailed after grades were posted. OF NOTE -- Some programs require undergrad transcripts (INCLUDING if you took a class at a community college or online). Be prepared to email the program director if you are unclear whether they want your undergrad transcripts or not. About half of my programs required undergrad while the others only wanted pharmacy transcripts. ANOTHER NOTE - None of my programs asked for an application "packet" but some of my peers' programs did. In that case you would have to order your transcript for pickup rather than direct mailing (same goes for letter of support).

6 -- APPLYING -- Some programs have application forms, some just require letters of intent and CVs, others require online submission. Make sure you are clear about the application materials. Once I had completed an entire application and sent it out (I sent them out at least 2 weeks prior to the deadline, asked the post office to put confirmation on them and when expected delivery was) I waited until a couple of days after the confirmation delivery date and then sent an email to the program directors informing them that I was applying to their program and all materials had been sent (note - I checked with my letter of support writers to make sure that they had sent their letters out) to them. All of the programs emailed me back saying that they have received my materials, which gave me peace of mind.

7 -- INTERVIEW OFFERS -- Most programs will contact you a couple weeks after the deadline has passed extending you an interview or politely declining. The programs I received interview offers from gave me a list of dates to rank for interviews. NOTE -- Keep track of the dates you are ranking for each place because a lot of the dates will OVERLAP and you need to make sure you don't rank Feb 3 for Program A as your number 1 choice and Feb 3 for Program B as your number 1 choice, as well. ALSO -- I ranked a list of four dates for program X and then program Y offered me an interview on one of those dates, I emailed program X to let them know my availability had changed and I was no longer available on that day. Some programs require a presentation and some programs require a patient case. Be prepared for that.

8 -- INTERVIEW PREP -- To prepare for interviews, I go through a bank of residency interview questions and try to answer that question. Even if the exact same questions aren't asked, similar questions will be and you will be able to pull from your practice sessions. I practiced with a friend (my BPFE - best pharmacy friend ever) who is also interviewing for residencies. It was nice to be able to bounce ideas off of each other. Don't be afraid to practice with a friend and give constructive criticism to each other. For example, if they give an answer that doesn't make them sound or look good, let them know because they are in an environment where they are able to think of another answer. We were bouncing questions off of each other and I gave several first attempts at answers that did not sound great, but after refining it, I felt comfortable giving an answer. I also participated in MOCK INTERVIEWS. If you are able to go to a mock interview through the school, I encourage it; if not, I encourage you to ask one of your past preceptors or employer if they would be willing to mock interview you. When taken seriously, mock interviews can feel like the real thing and even give you a sense of nervousness -- which is good to get out of the way before the real thing.

Before you go to the interview, research the institution, those who will be interviewing you, and the program. Be sure you know why you are applying to that program.

9 -- THE INTERVIEW -- Well I have only had two so far so I will comment on this more later. But I guess the best advice so far is to just relax and be yourself. Keep in mind that you are trying to see if it is a good fit for you as much as vice versa. Make sure you get a good night's sleep and wake up with enough time to get ready and get to where you are going. Unfamiliar cities can be scary and confusing when you are already nervous about an interview. The threat of being late will only enhance these anxieties. It is better to get there early and sit in a parking lot and collect your thoughts than to be frazzled and rushing.

That is all for now. I will let you know how things go....

2012 .. It's Finally Here!

Posted by Jenna at Saturday, January 07, 2012

2012 .. the year we've been waiting for is finally here! It's hard to believe that May 19th is right around the corner and that soon we'll join the list of distinguished Michigan Pharmacy Alumni. Just 4 rotations (or for some 5) stand in our way! 

2012 .. also a year of huge uncertainty. Many of us spent our winter break finalizing applications to PGY-1 residency programs or fellowships while others may have started job hunting. The next 3 months will be the most exciting, nerve-wracking, and unexpected times that many of us will face. Applications are in .. now we sit back and wait to hear back from programs, leaving our futures in limbo until that magic day in March, aka Match day. 

So, I'm trying to compile all of my advice regarding Midyear, residencies, and applications into 1 spot. Here goes nothing:

Before Midyear
1. Start identifying what's important to you in a residency.
2. Research, research, research. Go to Midyear prepared.
3. Work on an 'elevator speech' - who you are and why you want to complete a PGY-1 residency.
4. If you're looking at 'specialty' PGY-1 programs (administrative, pediatrics, managed care) or fellowships, join PPS. 
5. Come up with thoughtful questions to ask, it may help programs remember you if you deter from the 'run of the mill' questions.

At Midyear
1. Be yourself. 
2. At the beginning of each showcase, visit programs that are lower on your list to get your nerves out of the way. You don't want to be stumbling over your words at your top choice program.
3. Take 2 minutes after each program to jot down some notes, otherwise you're guaranteed to confuse programs when you go back later to jot down notes. It's okay to write (minimally) during your conversation, just try to maintain as much eye contact as possible. 
4. Be open-minded. Programs that were lower on your list may move to the top and vice versa.
5. Don't ask questions whose answers are on the program's website. 
6. Don't embarrass yourself when you're outside the convention center. It seemed like I saw a handful of people from my PPS interviews everywhere I went, which was nice!

After Midyear
1. Handwritten thank you's to everyone you spoke to, asap!
2. Make a master list of each program's application requirement. The 4 basic components are your CV, letter of intent, pharmacy transcript, and 3 letters of rec. Some programs specify who they want their letters from, some want your undergrad transcript, some have an online employer application, etc.
3. Get delivery confirmation once you send them. This helped me realize that one of my apps didn't get to the program! My faith in the USPS isn't the highest so I'd suggest FedEx for programs that want paper materials. 


I'll update the advice as more thoughts come to me :-)

A Bit Much

Posted by Matthew Lewis at Friday, November 11, 2011

As you well know, things are progressing on rotation, but outside of rotation, things are crazy. I am trying to get an abstract presentation for the International Society of Heart and Lung Transplant (ISHLT). My preceptor wants a draft by Tuesday, and the final submission is due Friday. The stats meetings are quite long, but every meeting is another factor put into the big picture. My project has generated at least 30,000 cells in Excel worth of data entry (yes, I'm counting blank cells because I did have to determine if they were supposed to be empty). I have a volunteering session at Hope Clinic on Wednesday night. Our dinner with donors to the College of Pharmacy is Friday night. I have a paper, a monograph, and an in-service all due and presenting on Friday, and I should have drafts of my monograph and in-service in by Tuesday, Wednesday at the latest. I'm not complaining mind you, I'm just telling you that sometimes it gets busy and storms of deadlines batter the USS P4.

Oh yeah, stack on Midyear planning. I have a great idea of where I want to go for residencies in and out of state, but I have to figure out who I'll be talking to and what questions to ask. I also have to prep my CV and get that squared away. I very recently came to the realization that not only do I want to do residency so I can be a clinical pharmacist, but I also would like to serve the US somehow in the US uniformed services. I say uniformed service because there is the army, navy, and air force under the department of defense, but there is also the public health service, which has a uniform, ranked members, and can be deployed to disaster areas (and overseas I think). The public health service, for those of you who don't know, are responsible for the FDA, Indian Health Service, CDER, and the CDC to name a few. So, on top of all the deadlines, I've got to figure out what the next five years of my life are going to look like. They all offer great opportunity and require, at the very least, immediate sacrifices in different areas.

On the matter of residencies, I was told that I should think of stories concerning patient care that will be important on interviews. This brought up my lung transplant patients, so I asked about two gentlemen in particular when I saw my preceptor for that rotation. They are both doing well, but each had a bout in the hospital, which was quickly resolved. I then asked about another patient, Mrs. B. She was waiting for new lungs and was deteriorating. Her problem was that she was a small patient and a more rare blood type. Nothing came up. She passed away. I had talked to her a few times just one on one during rotation and got to know her a little bit. When I showed her my laptop and that you could write on it. She wrote "Please get me new lungs." half in good spirits, half pleading at that time, knowing there was nothing we could do to speed the process. It hit me hard to learn she passed. That's the risk you run when you get to know people and they want desperately to stay alive with a poor prognosis. Our system and modern medicine can't help everybody yet. I just wish that I see cases like Mrs. B as few and far between as fate, God, and human effort will allow.

Residency Search ~ part 1

Posted by Jenna at Friday, November 11, 2011

Midyear is just 3 weeks away .. well CRAP, where did time go?! Despite all of the research I did this summer, I've been stressing over what to do. I wanted to attempt to put into words the internal struggle that I've been experiencing (which will come in the second post) as well as offer some advice on starting the search for a residency. 

Those that know me know that there are 2 ways to instantly put a smile on my face and distract me from whatever I was doing: golden retrievers & babies. 

Adorable! Now where was I?!

So, peds has been my thing since day 1 of pharmacy school. My first two years of pharmacy school, I shadowed a lot of pharmacists, both on the adult & peds side. I highly recommend this - almost all of the pharmacists are open to it and it's really great exposure. Starting last year, I began to look into different residency options. As my classmates who are looking into residencies can attest to, it's an overwhelming process. There are so many programs and so many things to compare, it's hard to know where to even start. Well, the best place to start is somewhere! Real profound, I know. 

So where did I start? I decided that I'm not going to geographically limit myself because I felt like this would be cheating myself out of possibly great programs and great people. I also decided that I'm not going to base my decision on anyone else, meaning I'm not going to stay in Michigan just because my boyfriend is here. In my opinion, this is a decision that I have to be selfish about. Not everyone would agree with this and there are certainly situations and circumstances where this isn't feasible. But this is the decision that works best for me and my life circumstances. 

After making this decision, I just started from the beginning (i.e. Alabama). I could've started from the end (i.e. Wyoming) but I decided that it's much easier to scroll down a page than up it. I went to ASHP's residency directory and just started to browse around. As I scrolled down through the states, there were certainly states I skipped right over because I couldn't imagine living there. I think you have to be honest with yourself .. some people will say 'It's just a year, you can do anything for a year.' I think that's partially true but a year is also a long time to be miserable so I ignored a few states where I just couldn't imagine living for a year.

Ordinarily I would've said to decide what you want prior to starting to search through programs. However, there are so many programs with so many things to compare. For me anyway, I didn't have any 'specifics' of what I actually wanted in a program, other than a hospital that had some pediatric opportunities. So I decided to just start looking. Some programs have more informative sites than others, so by finding programs with a lot of information, I started to get exposed to what looked interesting and what didn't. In my head, I started to formulate a list of 'things' that either were important to me or things that I would need to compare amongst places. One word of advice - write these down! For some reason I didn't and I could kick myself for it. I can't tell you how many times I've been to the same program's website .. because other than a huge word document, I didn't have a way to compare things. Literally, about two weeks ago, I started a spreadsheet so that I could have 'criteria' to compare amongst places. It looks something like this and still needs a lot of work, both with filling in the information and adding criteria to compare.

I still don't have all of my 'criteria' listed because I didn't have a running list of what I wanted to compare so I end up thinking of new things then having to go back through to update that information for each program! 

Utilize your resources. Ask your professors/mentors for their opinions on specific programs. This will naturally lend itself to them letting you know if they know anyone there because let's face it, connections get you places. It's important to consider their opinions but you also have to keep in mind that things may have changed since they last knew about the program. Another important thing to remember is that pharmacy is more advanced in some areas compared to others. The midwest and pockets throughout the rest of the country are 'known' for their pharmacy practice. Just because an institution is well known for their medicine doesn't mean their pharmacy practice is 'up to par.' 


I think that's enough for 1 post. Hopefully some of my suggestions help, to recap: 
#1. Where are you looking? Are you geographically limiting yourself?
#2a. Start from the beginning and just explore a variety of programs.
#2b. Start to identify what you're looking for and ways that programs differ (staffing, flexibility, etc) so that you have a method to compare them. Identify 'must have' criteria and 'nice to have' criteria.
#3. Utilize your professors for their opinion on certain programs.
#4. Keep in mind that just because an institution has great medicine doesn't always mean they have great pharmacy. 

Chugging Along

Posted by Matthew Lewis at Monday, November 07, 2011

First, I want to clarify something that I may have confused some people about. The Ann Arbor VA does have residency spots open for next year (2012-2013), and many of my classmates are quite serious about doing residency at some VA, either in Michigan or across the country. It's just that this current year there are no U of M grads as residents and all the current residents expected to have a Wolverine present due to our proximity. This coming year I'm sure we'll have at least one because of all the interest in the program and the Ann Arbor VA being a good fit.

Moving along, it's beyond the halfway point and I'm still feeling pretty good. I'm working on my projects and answering drug questions along the way. I feel pretty confident that most questions you will see on drug info has to do with "off label" indications or non-formulary drugs. As my preceptor explained, the doctors and nurses have more access to drug information from things like their iPhone or Blackberry than they ever had before.

Another thing I learned is that every pharmacist has their own way of practicing with their own habits and favorite drugs. It came to my attention for non-formulary drug requests, where doctors make their case for pharmacy to supply something that may cost more or be last line therapy for a patient. My preceptor does not like to approve particular tube feeding formulations without exacting data which shows a clear benefit which must be a better clinical outcome like going home earlier. On the other hand, he is more lenient with appetite stimulators for cancer patients. He's not a hypocrite since he does get data for both things, but in any evaluation, there is some subjective clinical decision making process that must go on. It'll be interesting to see when I practice what issues will be things I go on crusades for or against and what type of drugs I favor and try to avoid while keeping in mind the care the patient needs.

Interviewing for a PGY1 Residency Position

Posted by Shannon Hough at Thursday, February 18, 2010

January and February seem to be the big months for applying and interviewing for further pharmacy training. Jeff’s post really was an eye-opener about the process of applying for a fellowship in the pharmaceutical industry! I just completed my residency interviews (PHEW!), and thought that I’d share about the experiences that I had.

Those of you who have been following the blog, may remember that I am a commuter, and live in the Detroit area. I am looking to stay locally, so my interview experiences may differ than those of my classmates who have been traveling across the country for interviews.

That said, I applied to only four local programs. I received invitations to interview at all of them, and scheduled each of my interviews between January 26 and February 16. I was amazed at the interview process at each of the institutions, for many reasons.

Setting up Interviews:
You should expect to receive contact via e-mail, snail mail or telephone a few weeks after the application deadline, as to the program’s decision to schedule an interview or not. All of the programs that I applied to used e-mail. Most of them gave me 1 or 2 options for the interview date and time.

Preparing for Interviews:
Do your research about the programs. You should have a list of questions prepared that you want to ask each program. And I mean a list. You will be interviewing with a handful of people (think 3-8 separate interviews), and they will all leave time at the end for you to ask questions. You should think of thoughtful questions that will not seem like you are just asking questions because Dr. Kraft told you to in Opportunities in Pharmacy.

You should also be prepared to answer the “standard” interview questions. Give yourself time to reflect on your own strengths and weaknesses, and why you want to do a residency program. (HINT: you should know those 3 things!!) I also did some reading in AJHP about residency interviews. Mancuso and Paloucek do a nice job of summarizing what residency programs want to know about you. (Am J Health-Syst Pharm. 2004; 61:1686-9).

Most programs will send you an itinerary and directions weeks in advance. Be sure know out where you are going, where to park, if you need cash to park, and what the weather will be like in the morning for your drive. You can plan how many copies of your CV to bring with you when you have your itinerary. Most programs have copies for all interviewers, but it is a good idea to bring them along. Especially if you have made any changes since you sent your application materials.

During the Interview:
Relax! Engage yourself in the conversations with interviewers and residents. Don’t spend your interviews staring at the clock, gauging how much time will be left for you to ask questions. Don’t think about your next question while the person is answering your last question. Take advantage of the pharmacy residents you will meet. Ask if they are happy with the residency program, and other questions that are important to you. Remember, you are interviewing them as much as they are interviewing you!

Don’t be surprised by requests to test your abilities and knowledge. Be prepared to do small projects, answer clinical questions. Be prepared for situational interview questions. You should prepare a scenario of “when your recommendation wasn’t received well by the team?” and “what you are going to do if you don’t match?”.

After the Interview:
Set aside some time to compare notes from your other interviews. Be sure you take note of what you liked and didn’t like. Write thank you notes. The handwritten old fashioned style still brings a smile to the faces of the people who took time from their day to interview you.

The Next Step

Posted by Shannon Hough at Saturday, January 16, 2010

January already.

December came and went with the ASHP Midyear Meeting, the holidays

and residency applications. This year's ASHP Midyear Meeting was held in Las Vegas, NV. I attended the meeting in order to learn more about first year (PGY1) residency programs. I could not believe how many people were at the meeting, including the number of pharmacy students looking for residencies. The photo at the right was taken at a student poster session. The majority of people in the room were students! It was a great experience to be at such an impressive meeting.

After weighing all of my options, I decided where I wanted to apply. So I polished up my applications and sent them off. I requested letters of recommendation and transcripts. Most pharmacy residency programs stopped accepting applications in early January. Over the next few months, I hope to receive invitations to interview for a PGY1 placement, and keep my fingers crossed for a good match.

This month, I also started my rotation in inpatient hematology and oncology at the University of Michigan. This rotation is unique in that there are two hematology/oncology teams, each of which sees both types of patients. Each team spends half of the morning rounding with an oncology attending physician, and the other half with a hematology attending physician. I am on one of the teams, and follow all of the patients that one of the physicians on the team sees. So far, I can see a huge role for a pharmacist with these patients. Cancer can change how the liver, kidneys and bone marrow function. Chemotherapy regimens alone have complex, highly individualized toxicities requiring patient-specific therapy. I have had to consider all of these factors in learning about the care of this patient population.

The team that I round with is quite pharmacy friendly. My fellow P-4-parter-in-crime and I reply to many "Hey Pharmacy..." questions from our residents and medical students. The residents often times make changes to the patient medication profiles as we make our recommendations. (Just one more reason we need to be very accurate in our recommendations!) I'm looking forward to learning more about the pharmaceutical care of hematology/oncology patients as the month continues.