Emergency Department as APPE rotation?

[Ailiniel]

Has anyone done this rotation and what are your thoughts on it?

I am scared of choosing this rotation. I think I would rather go for a smaller hospital and also get to learn about infectious disease.

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[Dred Pirate]

Has anyone done this rotation and what are your thoughts on it?

I am scared of choosing this rotation. I think I would rather go for a smaller hospital and also get to learn about infectious disease.

I am a APPE ED preceptor - what are your concerns? People tend to have an irrational fear of the ed - most of my new rphs did

 

[Ailiniel]

It seems like a rotation where pressure is high because of the life and death situation of the patient. My retention of clinical knowledge is not strong to begin with so would especially make me nervous when residents and others ask what should be done.

 

[Dred Pirate]

It seems like a rotation where pressure is high because of the life and death situation of the patient. My retention of clinical knowledge is not strong to begin with so would especially make me nervous when residents and others ask what should be done.

the good news for you is that this rotation often can become a glorified shadowing session for those same very reasons. I honestly prefer a resident as I can have them work, a student, in those urgent situations we don't always have time for you (the student) to do work, plus, much of it you can't legally do, or the systems aren't set up to allow it (pull meds form pyxis, etc).

Depending on your particular ED - 90% of your time can actually be on the slow slide/non-urgent That being said, when things get ugly, they can get really ugly. You likely will see someone die - that sucks, even worse when it is a child. If you have issues dealing with this after the fact, there is no shame is asking your preceptor to talk about it - hospitals often have people specifically set up to talk to employees about this situations - most of the time, people often try to be "big and tough" and don't want to talk about their feelings, but there is no shame in it. I still remember the faces of every child (luckily it is a very small number as my hospital doesn't admit kids, and we have two peds specific ED's next to us) that I have seen pass away.

 

[Dred Pirate]

also - ED RPh's tend to be in demand more than other specialties - so take advantage of this and get trained. Ed is one area of pharmacy that is actively expanding in most hospitals vs ID which most places have had for quite some time

 

[confettiflyer]

My school’s ED rotation was the most sought after out of all of them. Level I trauma in Philadelphia and a dope ass preceptor.


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[smercer]

ED is an awesome rotation to do, especially if it is at a major trauma hospital. You will get to see a ton of things that you barely talked about in school. While ID can seem really interesting, it is kind of boring(at least to me). A lot of the information is based on infection location, typical bugs, hospital antibiogram, and C&S results. Thus, while you will learn a lot, most of it will be information you are reading from a resource and memorizing. Additionally, you can get ID experience during any inpatient rotation, as ID starts from the second an infection is suspected/diagnosed until the patient completes therapy or is discharged. However, you are not going to have many opportunities outside of the ED getting to experience how to handle traumas, overdoses, strokes, MIs, etc. You are paying a lot for your rotations and you only get a few, so do not let irrational fear prevent you from an experience that can be greatly beneficial.

 

[student089]

What would be the best resources for ER pharmacist? I'm currently working, half of my time in ER. But I don't feel I learn much. Any recommendation?

 

[Ailiniel]

I appreciate your responses. I feel they help make my decisions clearer and emergency room does sound worthwhile.

 

[Kelp103]

I did an ED rotation and loved it! You are gonna see some gross stuff and some sad stuff, but I think it’s a great learning experience.

 

[BidingMyTime]

I would go with ED over ID. You will see so much more variety in ED (and you will see plenty of sick people coming in for antibiotics, some of the same people will come in for antibiotics every other week or so, so plenty of ID in the ED as well.)

 

[njac]

I refer to my student rotation in the ED as “gentleman’s ID”. Meaning, on an ID rotation you’re likely doing a combination of stewardship and consults - consults are weird cases the primary team doesn’t always know how to handle. But in the ED we get a lot of the more straightforward cases that the guidelines apply directly to.

If your preceptor is doing their job you will never be in a situation where you’re making life or death decisons for a patient. If anything, on a busy, critical day I may assign you more straightforward patients so I can actually do my job.


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[sakigt]

I am a APPE ED preceptor - what are your concerns? People tend to have an irrational fear of the ed - most of my new rphs did

Love this irrational fear. I only get badass students.

I feel bad for my students so I only take them October-April out of fear they wont see anything cool. Most of my time is spent doing boring stuff like order verification. Although I had an 8.5/10 on the **** o meter while training a new Pharmacist. 5 code stroke, 1 tpa, 2 codes, 2 levophed drips, one RSI with post sedation titration on top of the usual med recs and 600 orders. Talk about a unicorn day.

 

[Rouelle]

The best APPE rotations to take are the ones that scare you.

 

[SpartanDOnoharm]

I was an ED preceptor as well. If you're thinking about ED in any way, or if you are interested in ID, or medicine in general I would recommend it. The cool thing about the ER is you see EVERYTHING. While it can be a rigorous and sad rotation, it can also be very rewarding. If you're scared about what you'll have to do and the high pressure, I'll tell you what I tell every student I had on their first day. "I will put you in situations that will hopefully make you uncomfortable and stressed. I will put you in situations where you are going to have to think about what the right answer is, and what the consequences of that answer are going to be. I will NEVER put you in a situation that will harm you, the patient, or others if you don't know the answer or are having trouble doing something. The point of the rotation is to get you exposed to as much as we can in our short time and help you learn from those situations, both the pharmacy and personal aspects of dealing with those situations. Welcome to the ER."

The nice thing about ED pharmacists, is we're generally all pretty easy going, they tend to be very hands on, and they all care deeply about their patients. I had one student who had a really hard time with a situation we had happen and the student wasn't ready to start seeing patients immediately afterwards. She voiced that to me, and she got to take a break until she was ready to go again. I don't know any ED preceptor that wouldn't do that for their students. Our job as the preceptor is to push you pass your comfort zone but we're people too, and we understand that sometimes the stress can be hard and that the ER isn't for everyone. At my hospital they were also some of the most highly respected people in the hospital, which gets you a lot of exposure to a bunch of different areas. It's a very unique and interesting rotation, and I always recommend people take it as ED pharmacists see and do things that the majority of pharmacists never get to see.

As far as ID goes...you'll learn a crap ton on your ER rotation. A lot of ED pharmacists also handle the microbiology culture results so you'll get plenty of time with ID. If you have anymore questions feel free to ask!

 

[Rockinacoustic]

I love students in the ED with me. You are an extender of services (med histories, patient counseling, procuring meds for codes while I review patient info, looking up physician DI questions).

I agree with njac that a good ED Pharmacist preceptor will never leave you out to dry in a critical situation. In fact, I'd argue an ED APPE has more one-on-one pharmacist-student time than any other APPE

It helps to be a type-b person. The type-a people tend to flock to ID...

 

[accordman83]

Has anyone done this rotation and what are your thoughts on it?

I am scared of choosing this rotation. I think I would rather go for a smaller hospital and also get to learn about infectious disease.

I had an ED rotation and is was my favorite rotation behind infectious disease, I highly recommend it.