Bad APPE rotation-residency

[Cattanova]

So I just received a C on my first ever rotation in a clinical setting at a major academic medical center. The major criticism I received was that I didn't interact with the rest of the healthcare team enough and didn't ask enough questions. Due to COVID-19 my rotation was remote and my only way of communicating with the rest of the healthcare team was through messaging to make recommendations, which I did. Also, I usually took it upon myself to look things up, and when I did ask questions I was met with "look it up yourself."

I also felt that they wanted me to make recommendations that I didn't feel were necessary or appropriate. When I messaged the physician to make those suggestions they acted like I was an idiot.

I just wonder how this will affect my chance of getting a residency. Are residencies absolutely necessary if I just want to work as a staff pharmacist nowadays?

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[deleted562805]

When making recommendations, do you provide reasons why your recommendation are correct? Did you cite sources, guidelines and studies etc? If the doctor still ignores you, then there is nothing you can do, but at least you provided a rational.
Secondly, recommendations that you didn’t feel was necessary or appropriate should have been communicated to other health care professionals and why it was not necessary.
Always remember the rational to why the guidelines made the recommendation. That’s what I learned in rotations and what my preceptors preached. You have to dig deeper than just saying the guidelines recommended this medication as first line. Preceptors and physicians want to why the medication is first line. ( does the medication reduce mortality etc).

There is no way you made C just because you did not ask questions or your recommendations did not get accepted.

Do you mind me asking these following questions?

1. How was your patient presentation skills prior to visiting the patient and after visiting the patient?
2. How did you do on the journal club or patient presentation or medication utilization evaluation?

 

[Cattanova]

When making recommendations, do you provide reasons why your recommendation are correct? Did you cite sources, guidelines and studies etc? If the doctor still ignores you, then there is nothing you can do, but at least you provided a rational.
Secondly, recommendations that you didn’t feel was necessary or appropriate should have been communicated to other health care professionals and why it was not necessary.
Always remember the rational to why the guidelines made the recommendation. That’s what I learned in rotations and what my preceptors preached. You have to dig deeper than just saying the guidelines recommended this medication as first line. Preceptors and physicians want to why the medication is first line. ( does the medication reduce mortality etc).

There is no way you made C just because you did not ask questions or your recommendations did not get accepted.

Do you mind me asking these following questions?

1. How was your patient presentation skills prior to visiting the patient and after visiting the patient?
2. How did you do on the journal club or patient presentation or medication utilization evaluation?

I couldn't visit the patient. I wasn't on site. Initially I was a little shaky on patient presentations but, they told me I had improved.

My journal club went really well. They complimented me on how thorough it was.

I provided rationale for my recommendations based on guidelines and patient specific issues.


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[deleted562805]

I couldn't visit the patient. I wasn't on site. Initially I was a little shaky on patient presentations but, they told me I had improved.

My journal club went really well. They complimented me on how thorough it was.

I provided rationale for my recommendations based on guidelines and patient specific issues.

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Okay, so journal club and patient presentation is not the issue.
Did this preceptor provide a mid point evaluation? In the mid point evaluation, did your preceptor point out the same problems you are positing on this forum or was it the just the patient presentation needs improvement?

Did you ever ask the preceptor or physician why they disagreed with your recommendation? Did you ever ask for their rational? Always cover for yourself in these rotations. Did you ever follow up on your questions to physicians or resident physicians? For example, if they told you look up a particular question, did you look up the question and followed up with them by saying I looked at theses such and such sources, but cannot find the answer. What do you suggest?

Also, Were you confident in your recommendations? Sometimes, I made the right recommendations, but I was ignored by a doctor due to lack of confidence in a one of my primary care rotations. Don’t worry that is something that can be improved in your next rotation.

Third, were you consistently getting better. Did you ask your preceptor every week how you are doing? Consistency is important in hospital rotation. You cannot have an off day in a hospital. Just imagine that you are the independent licensed consulting pharmacist. You are dealing with the lives of patients. Every day should be 100% to best of your abilities. That is what separates an A student from B to C students.

With respect to residency, do well on your other rotations (get As). Your primary care rotations, other medicine rotations and your DI rotation, if you are doing a DI rotation. This is the first rotation so learn from the experience. Also, are you doing a research project for Mid year? If not, I would to make your self stand out and so that this grade of C is just blimp in the radar.

To answer your question on whether you need a residency for a staff position, yes you do for working in suburban and urban areas. Hospitals in the cities prefer residency trained candidates. Hedgehog32 and other pharmacists on SDN can back me up on this.

 

[Cattanova]

Okay, so journal club and patient presentation is not the issue.
Did this rotation provide a mid point evaluation? In the mid point evaluation, did your rotation point out the same problems you are positing on this forum or was it the just the patient presentation needs improvement?

Did you ever ask the preceptor or physician why they disagreed with your recommendation? Did you ever ask for their rational? Always cover for yourself in these rotations. Did you ever follow up on your questions to physicians or resident physicians? For example, if they told you look up a particular question, did you look up the question and followed up with them by saying I looked at theses such and such sources, but cannot find the answer. What do you suggest?

With respect to residency, do well on your other rotations (get As). Your primary care rotations, other medicine rotations and your DI rotation, if you are doing a DI rotation. This is the first rotation so learn from the experience. Also, are doing a research project for Mid year? If not, I would to make your self stand out and so that this grade of C is just blimp in the radar.

To answer your question on whether you need a residency for a staff position, yes you do, especially for suburban and urban areas. Hospitals prefer residency trained candidates. Hedgehog32 can back me up on this.

The only feedback I received was that I needed to take ownership of my patients, which I was subsequently told I improved on.

I only wish that I had received more guidance. It was all online and I barely spoke with my preceptor. This was my first rotation.

As far as research projects go, I've already done one and I'm working on another one.



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[deleted562805]

The only feedback I received was that I needed to take ownership of my patients, which I was subsequently told I improved on.

I only wish that I had received more guidance. It was all online and I barely spoke with my preceptor. This was my first rotation.

As far as research projects go, I've already done one and I'm working on another one.



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Okay, I would recommend to take this rotation as a learning experience. You are going to do better in future rotations. Don’t let this grade make you doubt that you cannot handle residency. Believe that you can do a residency. Also, I did worse than you on my first rotation, so don’t get hard on yourself. I am a 2019 pharmacy grad so I mainly speaking from my own rotational experiences

However, I would recommend for future rotations to follow up with health care professionals who told you look up a particular question. Always be engaged in your future rotations. And always try to be open ended with your questions to providers, patients.

In order to avoid shakiness in patient presentations, definitely keep up with patients EHR the previous day and I would write little notes on a IPad on pertinent patient information, before presenting to preceptors. If I did not have access to Cerner remotely or the EHR remotely, I would always ask the preceptor if I can arrive 2 hours early to prepare for patient presentations. More than likely the primary care rotations may not provide remote access or have the resources to provide remote access to students. Hopefully you have access to EHR remotely in all your future rotations.

Not all rotations will have mid point evaluations remember that for future rotations. Majority of rotations do have mid points and final evaluations. It depends on the preceptor. Based on my experience,only one of my primary care rotations( which I hated) did not have a mid point, but I asked for feedback from my preceptor( who hated me) every week and turned that grade from C to a B because I had good communication with my preceptor. That’s extremely important. Also, likability and getting along with other staff members is also important. When a candidate interviews for residency, RPDs evaluate based on not just academic achievements, how you fit within their program. Are you likable? do you get along with other staff pharmacists? Do you get along with other health care members?

 

[BenJammin]

Chalk it up as one of those bad rotations you need to erase from your memory. One of my clinical rotations was terrible. The crew treated me like trash and my preceptor was a total *****. You know those evaluations they fill out at the very end? He gave me all 3s because "I'm not even a 4 so how can I give you anything more than a 3 on this evaluation?". I was lucky enough to get a clinical position after graduation and had the opportunity to deny employment to one of those pharmacists who wanted to join the team I led. They would not have been a good fit anyway.

 

[Twentytwelve2]

Ben is correct... I think -you- did nothing wrong. External factors are beyond your control. Let it not affect your mentality and move on with life. Humans come in many shapes and forms, and they assume every job out there. You were unlucky to get an a-hole for a preceptor. But that is also life. Sometimes you have a bad boss and have no option other than to resign and find a new one. Don't dwell on it. Move on. I believe in karma. GOOD things will come to you in life. Bad things will happen to them later in life.

 

[njac]

I’m sorry to hear that.

As a preceptor I am really, really not looking forward to having students on remote rotation this fall. I have no idea how I’m going to do this.


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[Seriously Serious]

Chalk it up as one of those bad rotations you need to erase from your memory. One of my clinical rotations was terrible. The crew treated me like trash and my preceptor was a total *****. You know those evaluations they fill out at the very end? He gave me all 3s because "I'm not even a 4 so how can I give you anything more than a 3 on this evaluation?". I was lucky enough to get a clinical position after graduation and had the opportunity to deny employment to one of those pharmacists who wanted to join the team I led. They would not have been a good fit anyway.

I have my list and I look forward to the day I have the opportunity, if it comes

 

[spacecowgirl]

Not an RPD anymore but I have to imagine the usual rubrics, as arbitrary as they may have seemed before, will be even more so in this crazy ass time. So I can't say how much it will affect your candidacy. I would have given a definite side eye to a C in a core rotation, but better it was your first because you can demonstrate improvement. If you're comfortable ask for really detailed feedback like, "give me an example if when I didn't do xyz (whatever they criticized you on) and what an A response would have been". In fact make yourself comfortable to ask that. Come from a place of really wanting to know vs being defensive. You have nothing to lose because either they'd never be a reference anyway or, best case, you'd turn it into a positive and they would be a good reference. People who are brave enough to ask for feedback, accept it with grace and then demonstrate change show a lot of maturity and teachability which is a huge plus to a preceptor.

 

[BidingMyTime]

Ummm, no advice, except try not to worry about it and move on. It is nasty if they graded you "normally", during COVID conditions, when you couldn't have a normal rotation. And sometimes, there are just bad rotations.

Although, I have to ask......is your school a "new" school (accredited within the past 15 years.....or God forbid, not accredited), or is it an old school? New schools often have to pay rotation sites, and new schools often accept any rotation site, even if they know it's going to be a crappy one.