4th Year Rotations?

[BeLikeBueller]

So I've been working on scheduling my 4th year rotations for the past few days. I am simultaneously excited and terrified.

I'm just kind of wondering what is expected on rotations? I have done well in the classroom, but I don't feel like I've retained a lot of what has been taught. That's normal though, right? (One of my professors said that on average students retain about 20% of the information they're taught) I know I'm going to have to put in a lot of effort and hard work on my clinical rotations - I'm prepared for that. And I really do want to learn as much as I can on rotations. But at the same time, I'm afraid I'm going to look like an idiot (at least in the beginning) and I don't want that fear of looking like an idiot to keep me from asking questions and learning as much as I can.

I am taking an elective course next semester that is supposed to help prepare students for acute-care rotations, so hopefully that will help serve as a good refresher for a lot of the major disease states.

I'm just kind of wondering if anyone has any advice on how to do well on/make the most out of clinical rotations.

[I know I shouldn't be worrying about this six months in advance, but what can I say? It's just the way I am...]

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[BenJammin]

My best advice? Lie, lie, lie. Don't tell any of your hospital preceptors that you have ever worked retail or have any interest in retail. Tell them you are 100% towards residency regardless if that's the truth. When you arrive at the hospital, the first question your preceptor will ask you is "what do you wanna do when you get out of pharmacy school". That's not curiosity, it's a test. If you don't answer that question correctly then they will not put much effort into teaching you about hospital pharmacy.

Unless I'm your preceptor then you will have a blast.

 

[Sparda29]

My best advice? Lie, lie, lie. Don't tell any of your hospital preceptors that you have ever worked retail or have any interest in retail. Tell them you are 100% towards residency regardless if that's the truth. When you arrive at the hospital, the first question your preceptor will ask you is "what do you wanna do when you get out of pharmacy school". That's not curiosity, it's a test. If you don't answer that question correctly then they will not put much effort into teaching you about hospital pharmacy.

Unless I'm your preceptor then you will have a blast.

Pretty much all of my preceptors knew that I worked at CVS for 4 years.

 

[StellargalS]

All corn aside being ur selfself slates you among the top 99th of the "rotators". You speak the language better than many a seasoned pharmacist.

Here are my mistakes that you can learn from.

1. Get familiar with the building - i.e. where is ICU, lab, pharmacies, cafeteria, etc, etc. I recommend keeping a mini pocket map. Some of these buildings are an architectural nightmare.
2. Plan for efficient data collection i.e. if you are rounding with internal med try to determine the top 10 dx you are likely to see and then think about the drugs used and the relevant monitoring. The chart has way more than we need. General example: Don't track the temp if its norm and there is no work up for infection. Maybe they have great apps for data collection these days but if not I have templates for use on papyrus reed. If interested PM me.
3. Stick to the drugs. I, like you, have a thing for medicine. I am easily enthralled and loose time out of bounds. Review the charts in terms of the drug therapy problems and not the accuracy of the diagnosis and other such doctor-doctor things.
4. Review the charts BEFORE you round. Sometimes patients get admitted overnight increasing the number of charts you will have to cover. You want to be up to speed so you can provide timely and relevant recommendations = on rounds. (It is totally ok if this takes a couple two four days to achieve.)
5. Don't select ball busting write ups for self enrichment until you have an excellent take on your ability to manage your time.
6. Hospital has an interesting culture. Don't be visibly taken aback by the cardinal wrong doings taking place before your eyes and in spite of your best effort to prevent them. It is just the way things are. The key is to establish trust with the docs and that takes a little time. Once you do you can intercept more effectively.


Dude! Your almost done.

 

[rxlea]

Make a list of all the things you need to monitor on your patients and go over them.

Make sure they are on home meds that aren't dc'd for a reason.

Make sure therapy is appropriate.

Know criteria for SUP, DVT prophylaxis, TPN versus enteral

Narrow abx when you can (you'll need to interpret cultures), IDSA guidelines, look at sensitivities

Ensure adequate pain regimen + anti emetics and bowel regimen if applicable. Poop is a big deal.

Know when to get levels on vanco, psychotropics (if needed), etc.


Kinetics: phenytoin, vanco, dig plus drugs with major interactions

Warfarin: know common interactions, goals, and protocol.

Know fluids and when to use each

Insulin

Dose adjustments for renal function

Those are just the quick and dirty off the top of my head

 

[zelman]

It all depends on your preceptor. Establish a good rapport and establish your value. Some will want you to contribute what you know and some will only want complete info (example: some would rather you say a Clozapine patient needs bloodwork 1-4 times a month depending on how long they've been on it and get the time frame for q4week monitoring later, others would rather you keep your mouth shut until you've memorized the specific criteria). Contribute within your area of expertise, and ask questions about others'. As said above, don't act like you're an MD, but if you're interested in something that comes up, most people like to talk about their primary knowledge base.

 

[BeLikeBueller]

Thanks for everyone who posted here! These all sound like great suggestions and I am going to save this thread for reference on rotations and to help direct some of my review over the next 6 months. Any other thoughts are, of course, welcome. But again, thanks to everyone who was kind enough to share these suggestions!

 

[owlegrad]

I have a link in my sig to a thread about rotations, maybe worth checking out.