US Pharm. 2008;33(12)(Student suppl):5-6.
When
I was a freshman in college, those "clinical rotation things" seemed so far
away. Now, as a sixth-year pharmacy student doing those "rotation things," I
cannot believe how fast the past five years have flown by. I did not realize
it, but from the moment I walked into my first class as a college student, I
was preparing for my advanced pharmacy practice experiences (APPEs). The
reader might be thinking, "What does Art 100 have to do with sixth-year
APPEs?" While analyzing the motivation behind contemporary art is not what
sixth-year APPE students do on a daily basis, the fundamentals learned in
classes such as this one taught me how to effectively communicate, prepare
professional documents, motivate myself to strive for excellence, and think
outside the box. I have completed three wonderful APPEs and can say from
experience that the life skills I learned early in my college career have
helped me succeed thus far. I encourage anyone who is about to select APPE
sites to do so thoughtfully and to pick one or two that may be a bit outside
his or her comfort zone.
Some of my experiences have
been challenging, but very much worth it. My first site was a pediatrics
rotation at Rainbow Babies & Children's Hospital in Cleveland, Ohio. My
typical day started off with three hours of rounds. During rounds, the medical
team--including physicians, nurses, pharmacists, dieticians, respiratory
therapists, and social workers--discussed the patient cases from their service
at each patient's bedside. The medical residents usually led the discussion
under the supervision of their attending physician. Discussions included a
history of the patient's present illness, current laboratory values, changes
from the previous day, assessment of the patient's condition, and the plan for
the current day. I chose to work in the pediatric intensive care unit (PICU)
for rounds. Frequently, the PICU attending physician would quiz the residents
about drug therapy. When they were uncertain, the residents always turned to
me, which made me feel like a vital component of the team. During rounds I
encountered many interesting cases, such as drug overdose, teen pregnancy,
lithium–amiloride drug interaction, posttransplant care, sickle-cell patients,
and more. During PICU rounds, I gained a tremendous respect for the people who
worked there because they maintained a highly positive atmosphere, even for
the children who were not expected to survive. In the afternoon, I either
presented patient cases to my preceptor and the other students on rotation
with me or went to the Poison Control Center located in the hospital. At the
Poison Control Center, we discussed calls made to the center and explained how
we would handle each call. The Poison Control Center director sometimes gave
talks about really interesting cases, such as serotonin syndrome and ingestion
of poisonous mushrooms. In my time at Rainbow, I had some great experiences
and learned that it is important to remember that children are not the same as
adults.
My second APPE was an
ambulatory-care rotation at University Hospitals Family Practice Center in
Cleveland. Although it was right next door to my first rotation, this rotation
might as well have been in another state because it was so different from my
first experience. This site was a medical clinic whose client base included
the medically underserved population of Cleveland. My primary responsibility
during my rotation month was to see patients and work closely with their
physicians. After a patient was taken to an examination room, I would speak
with him or her and take a history to find out exactly what brought the
patient to the clinic that day. During this time, I would check the patient's
blood pressure (if diagnosed with hypertension), counsel the patient about any
medications he or she had questions about, and make my own assessment of the
patient's condition. After this session, I would present the patient's case to
the physician, who would then ask for my assessment and plan. Often, the
physician would let me write the patient's prescription and simply sign the
order when I was finished. The physician and I would then go together to see
the patient to communicate our plan and perform any other physical
examinations or tests that were needed. Some conditions and tests I observed
during this rotation were hand-foot-and-mouth disease, acanthosis nigricans,
scabies, genital warts, Pap tests, trichomonas and bacterial vaginosis under a
microscope, and more. Between patient visits, one of my responsibilities was
to check prothrombin time/international normalized ratio (PT/INR; a measure of
a person's ability to clot blood) laboratory values faxed to the clinic by
local laboratories. Almost every patient I was monitoring had had deep venous
thrombosis or pulmonary embolism and required warfarin therapy to help prevent
another clot from forming. If a patient's PT/INR level was too low (prone to
clotting) or too high (prone to bleeding), I contacted the physician and
recommended a change to the patient's warfarin therapy. After getting the
physician's approval, I called the patient to make sure he or she understood
the change and why it was being made. Some of my other activities were to
prepare patient case presentations, which I gave to my preceptor and other
pharmacy students, and to attend lectures on topics such as sleep apnea,
childhood obesity, and antipsychotic therapies with the family-medicine
residents.
One of the most important
lessons I learned from this rotation was that the pharmacist may be the only
health care provider some patients interact with. This has helped me be
mindful of cultural, environmental, and socioeconomic differences that
patients may face. This rotation taught me that it is important for every
person to receive world-class care from his or her pharmacist regardless of
education level, socioeconomic status, or ability to pay.
My third APPE was at the
CVS/pharmacy corporate headquarters in Woonsocket, Rhode Island, where I
completed a drug-information rotation. I worked on many projects and was able
to focus on many of the areas that interest me. Every morning, I went to the
office and checked the daily health news. Weekly, I reviewed the news stories
with my preceptor and two students from the University of Rhode Island. This
allowed us to discuss news stories our patients might see and to formulate
responses to these articles in case our patients asked us about these news
events. Following my daily check of the news, I worked on several projects
that were expected to be completed by the end of my rotation. These projects
included presenting journal clubs, in which I discussed with my preceptor the
clinical impact of recently published studies; researching current trials
related to specific drugs to have on hand for legal or regulatory reference;
and writing a feature article for the Clinical FOCVS, a monthly
clinical newsletter that is distributed to every CVS pharmacist in the
country. Sometimes my preceptor forwarded to me drug-information questions
from store pharmacists to research and answer. Two examples of questions I
answered are: "Is there an interaction between azithromycin and warfarin?" and
"Do any of the ingredients in commonly used OTC cough and cold products
interact with HIV medications?" During my rotation month, I also worked on two
projects for the Pharmacy Operations department that will help make
compounding easier for CVS pharmacists and will allow pharmacists in selected
Florida CVS/pharmacy locations to offer flu vaccinations to their customers.
My preceptor was the Community
Pharmacy Practice Resident for CVS/pharmacy, and her major project was the
collection of unwanted and expired medications. The goal of this project was
to make sure medications were being disposed of safely, rather than being
flushed down the toilet and into the water supply. With help from several
volunteers, we collected more than 200 gallons of unwanted medications from
more than 100 Connecticut residents. It was inspiring to be involved in an
environmentally friendly service project and help a community served by
CVS/pharmacy. This APPE was an excellent experience because I was able to work
in the corporate atmosphere, execute projects that will reach thousands of
pharmacists, perfect my professional writing skills, network with students
from another college of pharmacy, and discover resources I can utilize as a
pharmacist.
Through my APPEs, I have
encountered many people and have learned many lessons from them that will
guide me in my career as a pharmacist. APPEs may seem scary to those who have
not yet embarked upon them, but I promise that they are really enjoyable if
you keep an open mind and have a positive attitude.
To comment on this article,
contact rdavidson@jobson.com.