Help me improve my rotation

[Pharmer Tony]

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I was asked to take over our hospital's P4 rotation. I have little experience being a preceptor, therefore, I would love some feedback from other preceptors and/or students (or former students🙂) I made an outline of what I expect the student to do each day; please see it attached.

This is intended to be a rough framework rather than an hour by hour schedule, the times are all approximate. I also anticipate the need to adapt it with the quality and interest of the students.

My main questions:
1. Is the pace reasonable? <---Most of my colleagues seem to think this schedule is crazy, however, none of them are preceptors. Truthfully, I believe it's a bit light, but I think the student should be allotted time to work on projects/SOAPs/stupid journals or whatever from the school.

2. Is it reasonable to expect the student to function semi-independently? There's various opinions about this from my coworkers, but I'm not doing this if I have to babysit 24 year-olds.

3. What other hospital related things could I arrange for the student to see and do to make his/her experience better? Is there too much ICU time? I feel like I missed something.

Background: Our institution is a 600 bed urban hospital. This is not a teaching hospital. ICU/ID rounds are informal. The goal is to give the the student 18 MICU beds, 16 SICU, 26 stepdown, +/- another tele floor.
The pharmacy utilizes a decentralized hybrid model. Pharmacists rotate through the patient care areas and work 10 hr days. Since there's staffing rotation I'm not the pharmacist supervising the student all the time. However, I do spend most of my days in critical care so I will be doing the majority of the precepting. I graduated in 2009.

The school tells me this an "adult patient care elective." I don't really know what that means, but I want this rotation to be about exposure to hospital pharmacy rather than taxing academically. I'm a very pragmatic practitioner and don't play games like stump the student with bull**** from Dipiro or trivia from trials. I want the student to feel like they can do my job at the end of the rotation instead of doing goddamn journal club.

Sorry for the rant at the end. Any feedback or insights would be appreciated.

 

[owlegrad]

I don't really know what that means, but I want this rotation to be about exposure to hospital pharmacy rather than taxing academically. I'm a very pragmatic practitioner and don't play games like stump the student with bull**** from Dipiro or trivia from trials. I want the student to feel like they can do my job at the end of the rotation instead of doing goddamn journal club.

Based on that alone, I would want your rotation. Good luck!

 

[rxlea]

How many TPNs do you guys do and when do you hang them? When is your cut off for changes?

 

[bacillus1]

The days are very long (7-7:30), even if it's 4 days a week. Would the school even let you have such a schedule?

Also, ask for more guidance from the school. You're really throwing all kinds of hospital/clinical pharmacy into this thing, so it ends up being a really broad rotation. That may be good, but I think then there will be tasks that overlap with other rotations. For us, "patient care elective" has over 10 subcategories, and "acute care" probably has around 7 or 8 subcategories.

 

[spacecowgirl]

First, I have never seen a 4 day week model with the off day being in the middle. What's the rationale for that?

1. Is the pace reasonable? <---Most of my colleagues seem to think this schedule is crazy, however, none of them are preceptors. Truthfully, I believe it's a bit light, but I think the student should be allotted time to work on projects/SOAPs/stupid journals or whatever from the school.

I think it's a crazy heavy schedule. You have to try to remember yourself as a P4. Or as a new Rph for that matter. You also have to remember that it takes more than 1 day to learn enough Epic to be able to find the things you're asking the student to do on Day 2. They are going to be really slow at navigating Epic at that point and it will take a lot longer for them to complete all those tasks. They will need a lot of help at that point because as easy as it seems for us, remember what it was like when Epic went live at your institution. If you weren't there then, ask other people because I'm sure they will remember it and not fondly.

2. Is it reasonable to expect the student to function semi-independently? There's various opinions about this from my coworkers, but I'm not doing this if I have to babysit 24 year-olds.

Definitely. You want to let them be independent but also to feel like they can always ask a question, always ask for help. Don't make them feel like a burden.

3. What other hospital related things could I arrange for the student to see and do to make his/her experience better? Is there too much ICU time? I feel like I missed something.

The school tells me this an "adult patient care elective." I don't really know what that means, but I want this rotation to be about exposure to hospital pharmacy rather than taxing academically. I'm a very pragmatic practitioner and don't play games like stump the student with bull**** from Dipiro or trivia from trials. I want the student to feel like they can do my job at the end of the rotation instead of doing goddamn journal club.

Sorry for the rant at the end. Any feedback or insights would be appreciated.

How long did it take you to feel competent as a hospital pharmacist? I guarantee it wasn't 5 weeks. I don't think that is the goal of an APPE at all. I appreciate what you're trying to do, but I think it's a bit unrealistic and I'm afraid it will backfire. I also don't consider journal clubs to be bullsh*t. When done well, they promote critical thinking, knowledge of stats, and thinking about statistical vs clinical relevance - and be able to distill all that into something usable. I think those are really important skills for any pharmacist to have. The schools you work with should provide a framework of what objectives need to be met.

I honestly think you could cut these duties in half and still have a busy rotation. What I'm not seeing is much time for the student to discuss what they've seen, questions they have, working on a treatment plan - that requires face-time with the student. We spend a lot of facetime with our students and it's shown in our evaluations. I graduated not too long ago and the rotations that were a huge waste were the ones where we were basically set free to wander on rounds without the preceptor. I don't think they should be spending all their time doing dosing, renal adjustments and looking up labs. Those are important parts of being a hospital pharmacist but it seems light on the critical thinking parts.

I would devote less time to the calculation-type activities and more to broader objectives. I like to have my students do things that will have lasting impact - developing protocols, DUE based on safety or finances, anything for PI/QA for the facility, inservices for nursing, stuff like that. They also like to do that knowing they aren't just doing busy work or acting as technicians. They're doing something useful for the site.

You have a good start but I would cut it way back and make sure you're meeting the objectives of the school.

 

[spacecowgirl]

I also ask the student on day 1 what they are interested in if it's an elective. I want to know what they've learned elsewhere, what they want to learn, what they think their deficits are. I don't completely tailor the rotation accordingly but I do take it into consideration. If they did a bunch of warfarin dosing elsewhere, I skip that.

ETA: Pharmacists Letter has some decent resources for preceptors. I also got a lot of ideas from ASHP and ACCP listserves.

 

[R2pharmD2]

As a "rising P1", I obviously don't know much about P4 rotations yet, but it sounds like you're off to an excellent start. My question though would be are YOU going to have time for all of the things you have scheduled for them though? Like you said, you want them to function semi-independently, but especially in your afternoon portions it sounds like you're going to be doing a fair amount of teaching. I hope my preceptors have your desire to provide a good rotation though!

 

[All4MyDaughter]

I think it's very ambitious, but possibly doable for a very well prepared, qualified student. For a student who hasn't had much exposure to hospital pharmacy, it's going to be a challenge. Just keep in mind that students will gain independence at VERY different rates. For instance, I do not know that students can learn the Epic AC model on Monday and be able to document in it independently on Tuesday. At least, not all students.

Being flexible and able to adjust expectations based on individual student characteristics is very important.

I also think it's important to build in time for projects that students need for their portfolios. Not knowing what individual school requirements are like in your area, I can only share the types of things I did for my portfolio projects in hospital pharmacy. I had to learn how to document ADR/ADEs and submit to Medwatch if appropriate. I had to provide an educational session of some sort for nurses - this was helpful in teaching me to think about how to tailor my message to my audience. I had Journal Club, and although I think most people hate it, it IS important to be able to effectively evaluate medical literature.



I don't think you should bog the student down with projects, but I do think in a five week rotation it is reasonable to require (for example):

• One Journal Club presentation/article review
• One educational presentation to nurses, techs, or some group other than pharmacists
• One patient case presentation/discussion
• One topic discussion led by the student
• One writing assignment of some sort - I have done patient newsletters, internal/staff newsletters or "Helpful Hints of the Month." On one rotation I was assigned a "hot" issue that my preceptor wanted a quick summary of and was required to evaluate and describe the issue in 2 pages or less. I once designed a patient educational brochure for coumadin clinic patients.
• One final presentation on a fairly broad topic like "Evaluation and Treatment of Delirium in the ICU" (the one I saw today). This type of presentation should incorporate guidelines AND review of pertinent literature. My last big presentation was on management of chronic heart failure. I incorporated the ACC/AHA guidelines but also covered the clinical trials that play a role in shaping guidelines (COMET, MERIT-HF, VAL-HEFT, RALES, etc).

That's all I can think of right now. I think you're on the right track and have the students' best interests in mind and that's important.

 

[Pharmer Tony]

Based on that alone, I would want your rotation. Good luck!

Thanks. I didn't mean to soap box so much. I didn't have a good DI rotation, guess I'm just bitter. LOL

How many TPNs do you guys do and when do you hang them? When is your cut off for changes?

The floors the student would cover have 6-8 / day. Orders are due by 1400 (I am pretty lax about this, and the IV room is USUALLY accommodating) The bags and hung at 2000.

If you're concerned about the student being overwhelmed from TPNs. Usual routine is to discuss the orders with the CCP / attending during rounds (in the morning) or page them afterwards. The orders are processed with an excel spreadsheet to do the volume calcs, electrolyte balancing, ca/phosphate check, DIR, etc. etc.

It's very fast and accurate. I would of course explain the math and clinical application behind the spreadsheet, but I'm there's no reason to make the student do dozens of math problems a day or something.

The days are very long (7-7:30), even if it's 4 days a week. Would the school even let you have such a schedule?

Also, ask for more guidance from the school. You're really throwing all kinds of hospital/clinical pharmacy into this thing, so it ends up being a really broad rotation. That may be good, but I think then there will be tasks that overlap with other rotations. For us, "patient care elective" has over 10 subcategories, and "acute care" probably has around 7 or 8 subcategories.

I believe it states (or should say) 7-17:30 which is 5:30pm. Sorry for the jargon and/or typo. There's 4 x 10 hour days.

The school sent me some manual that's hundreds of pages. The definitions of the rotations are very broad. Perhaps due to the diversity of practice settings. I believe this rotation falls within the guidelines in the book, but that doesn't really answer my questions.

I have submitted this outline to the school for feedback. I would like additional perspective.

 

[Pharmer Tony]

First, I have never seen a 4 day week model with the off day being in the middle. What's the rationale for that?

I usually work Wednesday evening. I could probably change it to Friday.

I think it's a crazy heavy schedule. You have to try to remember yourself as a P4. Or as a new Rph for that matter. You also have to remember that it takes more than 1 day to learn enough Epic to be able to find the things you're asking the student to do on Day 2. They are going to be really slow at navigating Epic at that point and it will take a lot longer for them to complete all those tasks. They will need a lot of help at that point because as easy as it seems for us, remember what it was like when Epic went live at your institution. If you weren't there then, ask other people because I'm sure they will remember it and not fondly.

Epic isn't a difficult system to use and the P4s pick it up fast. Must be all the television or smartphones or something. I was hired PRN to help with the go-live in 2009 and then offered a job after it was over. It was not a fun time, fortunately things are much better now.

How long did it take you to feel competent as a hospital pharmacist? I guarantee it wasn't 5 weeks. I don't think that is the goal of an APPE at all.

I felt ready somewhere between halfway and end of rotations, However, I worked in hospitals all through school. What is the goal of an APPE if not to get us ready for practice?

I appreciate what you're trying to do, but I think it's a bit unrealistic and I'm afraid it will backfire. I also don't consider journal clubs to be bullsh*t. When done well, they promote critical thinking, knowledge of stats, and thinking about statistical vs clinical relevance - and be able to distill all that into something usable.

I didn't mean to offend. Good JCs can be useful and enlightening. Most of the ones I've seen like that have been from residents or fellows.

The school requires some number (2?) of them. If the student wants to do one I'm fine with it, however, I don't think it's a good learning experience for them. Pharmacy students generally do not do good or useful journal clubs. Majority of the ones I've seen have been flawed and not particularly insightful. I can't fail someone for doing a mediocre job on some random trial. The majority of them are bull****. YMMV

I want to show students more real world application and problem solving. They'll get plenty of type critical thinking and analysis you're talking about on DI or a faculty rotation.

I honestly think you could cut these duties in half and still have a busy rotation. What I'm not seeing is much time for the student to discuss what they've seen, questions they have, working on a treatment plan - that requires face-time with the student.

I'm not going to cut them loose after a week and then not speak with them until the midterm. Obviously I would review all treatment recommendations to team the student is going make. I am planning on adjusting the workload to the student's ability. If they can only cover 10 patients in the MICU at week three, we will work from there. Maybe this is too much work. Time will tell.

I would devote less time to the calculation-type activities and more to broader objectives. I like to have my students do things that will have lasting impact - developing protocols, DUE based on safety or finances, anything for PI/QA for the facility, inservices for nursing, stuff like that. They also like to do that knowing they aren't just doing busy work or acting as technicians. They're doing something useful for the site.

You have a good start but I would cut it way back and make sure you're meeting the objectives of the school.

Eh the "calculation type activities" don't take any time. Excel does all these dose/kinetic calculations. 5-10 minutes for a new protocol. 5 min for a level. Most of time is discussing the plan with the student. The go on to the next thing while I enter the orders/note into Epic. (Which takes almost as much time.)

There's a spreadsheet that suggests renal doses. No fumbling with micromedex/lexi. The student just needs to read the notes to find the appropriate indication, punch in the CrCl and write it down the answer. I take the finish product review it and do the orders (again which takes most of the time.) An entire floor takes 25-30 min.

Simple, easy, fast. ~5-10 levels/shift (we do levels all three shifts, so there aren't as may as other places) ~5 new starts. That's like an hour's, 1.5 hrs worth of work for the student if they do all of them.

The idea about projects is a good suggestion. I will budget time for these. Thank you.

 

[Pharmer Tony]

I also ask the student on day 1 what they are interested in if it's an elective. I want to know what they've learned elsewhere, what they want to learn, what they think their deficits are. I don't completely tailor the rotation accordingly but I do take it into consideration. If they did a bunch of warfarin dosing elsewhere, I skip that.

ETA: Pharmacists Letter has some decent resources for preceptors. I also got a lot of ideas from ASHP and ACCP listserves.

I had a preceptor that asked me that, and he did make extra time for me in the ICU. (My interest) I had forgotten (2008 seems far away) he tailored the rotation for me, thank you for reminding me. I will try to do this.

A lot of students seem to have AC Clinic experience. I will skip it if they had an one, unless they want more experience. Maybe more time at Onc? That just sort of started in Jan and I think the pharmacist is still building the program though. Maybe a project day or two since I am overwhelming them???😎

I will hit up those resources. PLetter always seems geared toward community, but I will check it out. Already subscribed to ASHP and ACCP as of Monday. More email...

As a "rising P1", I obviously don't know much about P4 rotations yet, but it sounds like you're off to an excellent start. My question though would be are YOU going to have time for all of the things you have scheduled for them though? Like you said, you want them to function semi-independently, but especially in your afternoon portions it sounds like you're going to be doing a fair amount of teaching. I hope my preceptors have your desire to provide a good rotation though!

Theoretically the student should be doing all my work, so expect me to be on SDN all day.

Seriously though, I'm not planning on going to cathlab or activity du jour with them if that's what you're asking. As far as the afternoon to review stuff, the department schedules an "overlap" person every weekday with no specific responsibilities. This person goes to meetings and or works on protocols, programs, etc, etc. He/she can cover for me or bat clean up with the student gets everything behind.

We don't know it's a good rotation yet.

 

[Pharmer Tony]

That's all I can think of right now. I think you're on the right track and have the students' best interests in mind and that's important.

Thanks. The book from the school has similar requirements (Thanks to ACPE I'm sure.)

Based on the responses, I am going to cut down the daily workload (How many vancos/TPNs does a student really need to see anyway?) and schedule some time for projects. A coworker pointed out this will probably make my life easier as well and less likely to get burnt. (Mentoring students is time consuming...)

Would it be best to have time off at the site or at home?

PS sorry for the multiple replies. They were getting too long for one post.

I'm off to bed.

 

[All4MyDaughter]

Thanks. The book from the school has similar requirements (Thanks to ACPE I'm sure.)

Based on the responses, I am going to cut down the daily workload (How many vancos/TPNs does a student really need to see anyway?) and schedule some time for projects. A coworker pointed out this will probably make my life easier as well and less likely to get burnt. (Mentoring students is time consuming...)

Would it be best to have time off at the site or at home?

PS sorry for the multiple replies. They were getting too long for one post.

I'm off to bed.

Time off at home or at the site? I think that depends on how much space you have at your site and whether the students will have access to a computer to work on projects. I've been at sites where the students had their own work room, which was great. But I have also been places where there was absolutely no room to spare or I had to share a computer with three other students (the suck). One site (VA) had great access to helpful resources like online journals, UpToDate, Micromedex, etc. Another site that shall remain nameless had such a restrictive internet filter that you could barely even Google stuff.

If you have students work at home on projects I think it's helpful to establish intermediate deadlines so that you know everything is progressing. For example:

Week 1
Topic discussion subject due to preceptor for approval

Week 2
Topic discussion on ___________
Journal article selection due
Nursing/tech education proposal due to preceptor

Week 3
Newsletter article proposal due to preceptor
Main project proposal due to preceptor
Journal Club - end of the week

Week 4
Nursing/tech educational presentation
Newsletter article due

Week 5
Main project/final presentation

If I had several students at once, I'd have weekly topic discussions with a different student leading each week. Or choose a broad topic for each week and then let each student focus in on one aspect of it and present that for 5 to 10 minutes to the group.

Tomorrow my fellow students and I are having a topic discussion on oral meds and non-insulin injectibles for DM. We've divided them up and we'll take turns. I'm doing Symlin, metformin and alpha glucosidase inhibitors. Another student is doing Byetta, TZDs and sulfonylureas. This is for an amb care DM rotation but the general idea is adaptable to any rotation.

 

[bacillus1]

I believe it states (or should say) 7-17:30 which is 5:30pm. Sorry for the jargon and/or typo. There's 4 x 10 hour days.

The school sent me some manual that's hundreds of pages. The definitions of the rotations are very broad. Perhaps due to the diversity of practice settings. I believe this rotation falls within the guidelines in the book, but that doesn't really answer my questions.

I have submitted this outline to the school for feedback. I would like additional perspective.

Sorry, that was a typo on my behalf. I still think those are long days. I would expect to be at my rotation 40hr/week but 5 days a week, + whatever home projects they assign. 4 days a week just seems strange. You can always ask the school's rotation coordinator though. I'm sure they wouldn't mind answering whether a 4-day week is fine.
I would just say do M-F 7-3:30.

 

[Farmercyst]

Elective or Required rotation?
Which rotation blocks?

I ask because, as a P4 with only community experience, my first required rotation was my acute care rotation, and I was completely lost. Hybrid paper chart with Cerner access for notes/labs. CVT Surgery setting. Weeks 1-3 ICU, Weeks 4-6 Stepdown unit. Can you imagine someone with little/no hospital experience stepping in day 2 and trying to figure out the ICU. I do like how you have built in intro time to familiarize the student to the facility and it looks like a pretty good gradual increase in duties, but I can tell you it'd still be a little fast for me if this was 1 week after finishing didactic lectures to step into and be expected to run the joint in 5 weeks (or 6 in my case)

I think what I'm trying to say is take into account student experience and timing of the rotation into account and adjust expectations accordingly.

 

[spacecowgirl]

Epic isn't a difficult system to use and the P4s pick it up fast. Must be all the television or smartphones or something. I was hired PRN to help with the go-live in 2009 and then offered a job after it was over. It was not a fun time, fortunately things are much better now.

I'm pretty computer savvy and have used Epic for 4 years now. I still learn new things about it every single day. How long is the Epic orientation at your hospital? I'm just saying from experience as a preceptor, new users are really, really slow with what are technically easy duties. Remember it will take a lot longer simply to find where in the chart the problem list is, the micro, the labs, etc.

I felt ready somewhere between halfway and end of rotations, However, I worked in hospitals all through school. What is the goal of an APPE if not to get us ready for practice?

The goal is to train a pharmacist that can be ready to work in a variety of practice settings. Baseline skills. Your students may not plan to work in a hospital but feel like your rotation will be better for them for the NAPLEX or whatever. I think it's unrealistic to prepare a pharmacist to do your job in 5 weeks. I have been working in a hospital for 3 years as a pharmacist and I learn every.single.day. I too worked as an intern in a hospital and although that probably helped a bit, my duties were nothing like a pharmacist's.

I didn't mean to offend. Good JCs can be useful and enlightening. Most of the ones I've seen like that have been from residents or fellows.

The school requires some number (2?) of them. If the student wants to do one I'm fine with it, however, I don't think it's a good learning experience for them. Pharmacy students generally do not do good or useful journal clubs. Majority of the ones I've seen have been flawed and not particularly insightful. I can't fail someone for doing a mediocre job on some random trial. The majority of them are bull****. YMMV

Your students may be residency-bound in which case, JC will be very useful practice. Most of my students have struggled with JC and while they complained, they were thankful for more practice. I have to approve the article so I can make sure it's something relevant to practice. I also have them submit a draft first.

I want to show students more real world application and problem solving. They'll get plenty of type critical thinking and analysis you're talking about on DI or a faculty rotation.

Why not do that in every rotation? I'd like to see more common themes across practice settings. I like to revisit topics they have already covered since they are more likely to really understand the material on their second go-round. Don't you use critical thinking every day?

I'm not going to cut them loose after a week and then not speak with them until the midterm. Obviously I would review all treatment recommendations to team the student is going make. I am planning on adjusting the workload to the student's ability. If they can only cover 10 patients in the MICU at week three, we will work from there. Maybe this is too much work. Time will tell.

Ok.

Eh the "calculation type activities" don't take any time. Excel does all these dose/kinetic calculations. 5-10 minutes for a new protocol. 5 min for a level. Most of time is discussing the plan with the student. The go on to the next thing while I enter the orders/note into Epic. (Which takes almost as much time.)

There's a spreadsheet that suggests renal doses. No fumbling with micromedex/lexi. The student just needs to read the notes to find the appropriate indication, punch in the CrCl and write it down the answer. I take the finish product review it and do the orders (again which takes most of the time.) An entire floor takes 25-30 min.

Simple, easy, fast. ~5-10 levels/shift (we do levels all three shifts, so there aren't as may as other places) ~5 new starts. That's like an hour's, 1.5 hrs worth of work for the student if they do all of them.

The idea about projects is a good suggestion. I will budget time for these. Thank you.

Like I said before, it takes time just to know where in Epic to find the information. Calculating a CrCl might be easy, but finding a ht and wt can sometimes be a challenge if it's not entered for that encounter. If it's that rote, I think it's not that valuable to do it over and over and over again.

Just my experience/opinion. You'll have to try stuff out and find out what works and what doesn't. make sure your schools give you student feedback. Solicit feedback from the students in the "exit interview". I learned a lot from when I started.

 

[spacecowgirl]

If the student wants to do one I'm fine with it, however, I don't think it's a good learning experience for them. Pharmacy students generally do not do good or useful journal clubs. Majority of the ones I've seen have been flawed and not particularly insightful. I can't fail someone for doing a mediocre job on some random trial. The majority of them are bull****.

Sorry, I feel compelled to highlight this again. It's not a good learning experience if you are not providing the guidance along the way and the proper feedback when the JC is presented. The presentation itself, IMO, is not the point of the JC. It's the process and then the evaluation of their conclusions that makes it good. Don't write it off as a poor activity because you think, generally, pharmacy students aren't good at it. Pharmacy school prepares you to memorize and regurgitate facts. Rotations and then work should go beyond that sort of mechanical learning.

And for God's sake make sure the attendees read the article first!

 

[Pharmer Tony]

Time off at home or at the site? I think that depends on how much space you have at your site and whether the students will have access to a computer to work on projects.

I'm only taking one student for now. Space is a slight concern in the middle of the day when there's shift overlap, but there's plenty of computers available not in the pharmacy, e.g. the med library or on the floors. The hospital has the basics (micromedex/lexi/uptodate and a WKH/ovid subscription) but it's not as extensive as the school's library.

If you have students work at home on projects I think it's helpful to establish intermediate deadlines so that you know everything is progressing. For example:

Frankly I'm not doing this sort of micromanaging. The student should be able to figure this out. I have no problem failing someone for not completing an assignment or doing a bad job because they ran out of time. (Bad quality in a preceptor??)

I think I'm going to leave it up to the student where they want to work on projects.

 

[Pharmer Tony]

Sorry, that was a typo on my behalf. I still think those are long days. I would expect to be at my rotation 40hr/week but 5 days a week, + whatever home projects they assign. 4 days a week just seems strange. You can always ask the school's rotation coordinator though. I'm sure they wouldn't mind answering whether a 4-day week is fine.
I would just say do M-F 7-3:30.

Blah these aren't long days, plus they aren't going to working the entire time. I put in 5 x 12-13 hrs at the VA for 5 weeks. If a student seriously objected to this I might change it depending on the argument.

 

[All4MyDaughter]

Frankly I'm not doing this sort of micromanaging. The student should be able to figure this out. I have no problem failing someone for not completing an assignment or doing a bad job because they ran out of time. (Bad quality in a preceptor??)

I think I'm going to leave it up to the student where they want to work on projects.

I agree that students SHOULD be able to handle it, but after working with tons of different students this past year, I know some are better at it than others. Failing the students is always an option, but I'd rather work with them to help them establish good habits and give them a chance to improve. Especially if it's one of their first rotations. But if, given appropriate guidance, they STILL don't get things done or do a bad job, then their grades should reflect that.

If they wait until the last week to complete and submit all these projects, it's going to suck for you as preceptor too. Remember that! 🙂

EDIT: Also, if you fail a student, do you have to take them on as a repeater? That could suck.

 

[All4MyDaughter]

Sorry, I feel compelled to highlight this again. It's not a good learning experience if you are not providing the guidance along the way and the proper feedback when the JC is presented. The presentation itself, IMO, is not the point of the JC. It's the process and then the evaluation of their conclusions that makes it good. Don't write it off as a poor activity because you think, generally, pharmacy students aren't good at it. Pharmacy school prepares you to memorize and regurgitate facts. Rotations and then work should go beyond that sort of mechanical learning.

And for God's sake make sure the attendees read the article first!

Excellent points. And those residents and fellows who are good at presenting at Journal Club didn't start out that way. They started out as pharmacy students who were NOT good at it. Some of the best presentations I've attended were done on mediocre-to-bad trials. I think learning how to debunk crappy trials is very, very important. Drug companies are always trying to sell health care professionals **** based on shoddy or skewed evidence. Being able to evaluate and explain that to prescribers is an important role of pharmacists, IMO.

 

[Pharmer Tony]

Spacecowgirl, I don't want to get into a big debate about Epic. It's not a difficult or complicated system. (Trouble finding labs; there's a lab result tab right on the chart!) Epic is a highly configurable system, perhaps your IHT group needs some feedback from users. Example: the height is automatically copied from previous encounters for adult patients on our system. (It wasn't always like this, we had to cajole the Epic folks.)

Anyway the student will get proficient at doing all this stuff quickly because they will have to do several times a day from all the work I'm giving them.😀

Sorry, I feel compelled to highlight this again.

I will try to do this if a student does a JC. Being able to understand an article and apply it to practice is important. I don't think a journal club presentation is the only way (or the best way) to do this, although it certainly is the most tedious.

 

[ucrx]

I think the biggest thing for me is to make sure the student feels like they are there to learn, not being treated as another person to help get the job done. Discuss everything with them. Point them in the right direction or provide resources for them to learn about the new medications or disease states they see.

I'm not going to cut them loose after a week and then not speak with them until the midterm. Obviously I would review all treatment recommendations to team the student is going make. I am planning on adjusting the workload to the student's ability. If they can only cover 10 patients in the MICU at week three, we will work from there. Maybe this is too much work. Time will tell.

That's a lot of ICU patients for a student who has other duties. Understanding the complexity of problems in MICU patients takes time and probably a lot of reading because not many schools really cover critical care topics well before rotations.

Eh the "calculation type activities" don't take any time. Excel does all these dose/kinetic calculations. 5-10 minutes for a new protocol. 5 min for a level. Most of time is discussing the plan with the student. The go on to the next thing while I enter the orders/note into Epic. (Which takes almost as much time.)

There's a spreadsheet that suggests renal doses. No fumbling with micromedex/lexi. The student just needs to read the notes to find the appropriate indication, punch in the CrCl and write it down the answer. I take the finish product review it and do the orders (again which takes most of the time.) An entire floor takes 25-30 min.

What's the point of having them do calculations if it just involves punching numbers into a spreadsheet? They won't remember the formulas or even what factors into them if they don't even need to look at a formula.

Example: Who remembers how to calculate CrCl? There are many pharmacists who rely on their computer system to provide the information and never calculate it themselves anymore.

Also, you mentioned DI and faculty rotations as the appropriate place for analysis and critical thinking. I'd argue that should be everywhere, and that all pharmacists should be using critical thinking skills and analyzing orders they receive. Remember that some students may not have DI or many faculty rotations.

I don't think 10 hour days is a lot to ask when there is a day off. The majority of my clinical rotations involved 10 hours M-F plus work at home.

 

[spacecowgirl]

Spacecowgirl, I don't want to get into a big debate about Epic. It's not a difficult or complicated system. (Trouble finding labs; there's a lab result tab right on the chart!) Epic is a highly configurable system, perhaps your IHT group needs some feedback from users. Example: the height is automatically copied from previous encounters for adult patients on our system. (It wasn't always like this, we had to cajole the Epic folks.)

Sigh. I'm done with this part of the discussion, you have no idea how much work I do with Epic. Srsly.

I will try to do this if a student does a JC. Being able to understand an article and apply it to practice is important. I don't think a journal club presentation is the only way (or the best way) to do this, although it certainly is the most tedious.

I would recommend you check out Preceptor's Letter (part of PL). The university I precept for provides a membership. There are some webinars on providing feedback, incorporating students into your site, promoting clinical decision making, etc. IMO, that is your #1 job as a preceptor; If I haven't made you better at making clinical decisions, I have failed you as a student (now you know why in other threads, I think it total BS when sites are not paid, I devote a lot of time and energy to precepting!). The experience is only as good as the teacher. You don't want to call it "journal club", no skin off my nose but please don't have your students doing hours of calculations.

I'm not trying to dog you, but you sound like a ballbuster and I'm not sure why. I certainly would fail a student if I felt they were unprofessional or if the thought of them getting licensed literally frightened me. But I would work with them before getting to that point. You are going to see a wide variety of students and the same methods don't work for everyone. I have had IPPE students that were far superior to some APPE students. I've had APPE students that handled everything I threw at them and then some. I'm certainly not of the "everyone is a special snowflake" mentality, not at all. I can't stand students that feel entitled to an A. But I like working in a more collaborative type of teaching relationship. I get more out of the student, they get more out of the rotation.

 

[Pharmacy Kid]

You guys just violated the first rule of journal club . . .

 

[The Fargoan]

Nearing the end of my rotation year I can honestly say I have gotten little out of rotations that threw me to a new pharmacist every 2-3 days. Renal and warfarin dosing protocols are just things to follow. I wasn't required to think, just follow the protocol. And after the first day it's just not that interesting.

I've learned the most when allowed to dig through patients on my own, then present them to my preceptor. We discuss disease states, therapies, reasons for/against bringing something up to a doctor. As a student I know the guidelines, I can recite facts. What I need is somebody making clinical decisions to explain HOW and WHY they are doing something. I function best when discussing my own recommendations with the preceptor and then learning whether or not it's reasonable. I spend about 1 hr/day with my preceptor and learn way more than the rotations where I sat and watched an RPh verify orders for 8 hours.

I've also enjoyed RPhs that have some prepared topics they like to discuss with students. One ICU pharmacist had an acid/base presentation he trotted out for every student. He grilled me with a ton of questions I hadn't necessarily seen/thought about since Renal a year ago. It was uncomfortable but worth it when I consider how much I learned.

Good luck! Enjoy your student and be willing to take constructive criticism/change your methods if they don't work.