I'm Not Suited to be a Pharmacist

[Oink]

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I'm in my final year of pharmacy school and just started my third rotation. I've always been a calm and relaxed person. I am rarely the type of person to become really stressed and nervous about things. I am horrible at memorizing things, but good with math and numbers. Even when I did bad in some classes, I never really stressed out because I knew I would pass my classes somehow (but end up with a C).

Starting from my last didactic year in pharmacy school, things starting becoming different about my ability to remain calm. For example, I would get nervous whenever I had to present a case in front of a group. It was especially nerve wracking to me when I knew I would have to answer questions on the spot. I hate the fact that I am really bad with memorizing because I'm always thinking stuff like, "dang how do all these people remember these facts??" "How come I can't remember that?" My nervousness even caused me to fail a case presentation for one of my classes, and I was very close to failing the whole class. Luckily, I was able to remediate by passing another case presentation. I always thought I was just being a big baby with all these nervous feelings I've been getting. I kept telling myself to suck it up and be calm the next time. I wasn't like this before, so I hoped that my anxiety wouldn't show in the future.

I did my first two rotations at small independent pharmacies and they went pretty well. All my work experience has been in retail so that is probably why I was comfortable in those rotations. However, I am now in my Am Care rotation and the whole environment is new to me. I just finished my first week of Am Care but I was so nervous that everything went straight out the window. That includes all my knowledge from classes, my ability to think, my professionalism, etc. My preceptors had to give me a lecture, and basically told me that I will fail this rotation if I continue to act like this. After talking to them for a little bit, they basically told me to calm down and work hard. After that lecture, I started working at a slower pace and one of my preceptors said I am starting to improve. However, my embarrassing performance from the first week got me so anxious that I still felt anxious this whole weekend. My head hurts just from thinking about what happened that week. I really don't want to go back to rotations this Monday. I get so nervous when my preceptor asks me to look up stuff because I'm scared of not being able to find any information. One time, my preceptor asked me to look up something about a drug and I couldn't find anything after spending hours on researching the question. I was really confident that there is no information on the question, but I was afraid that possibly I'm just really bad at looking up stuff.

I have been thinking about quitting pharmacy school ever since I started getting these nervous episodes. My first week of Am Care rotation was my worse nervous episode I have experienced ever. I feel really incompetent because I'm definitely not a clinically minded person compared to most of the other students. I am trying so hard to review disease states and drugs related to this rotation, but I feel like I am still dumb compared to everyone else. I really don't know if I can keep this up. What really worries me is that I haven't even had my hardest rotation yet. What if I keep trying and I fail this rotation anyway? My head hurts so much, I feel like my head is in a microwave. I'm assuming having a job as an actual pharmacist would be harder than a student doing their rotations. I keep telling myself I should've went for an easier job. I don't care about making that much money as long as I am happy (or at least okay with my life).

 

[ldiot]

Figure out the most common disease states that you will encounter and study them. Learn how to find reliable and concise information quickly. My advise would be to communicate with your preceptor as much as possible; ask for feedback on a regular basis and highlight opportunities for improvement. If your preceptor sees that you are taking a proactive approach and working to improve it will make it harder for them to fail you. It's okay to ask questions, but only if you've done your research before hand, otherwise they will call you out on it and tell you to look it up which just makes you look lazy/disengaged.

Get a pocketguide to carry with you or download lexi-comp on your phone. Have multiple resources that you are familiar with to reference.

 

[mustang sally]

You made it this far, so give yourself a chance...it sounds like you're overly stressing yourself out.

I actually think pharmacy school was harder in some aspects than being a pharmacist due to all the bs surrounding the academic world and how you're stuck in a fish bowl with the same classmates day after day. There are days when being a pharmacist can be stressful, but I'm way more calmer now than I was during school. N = 1.

 

[Amicable Angora]

Could you give examples of the "unprofessional" behavior you exhibited?

 

[sdpcat]

Very normal feeling. youre just starting.

 

[gwarm01]

You made it this far, so give yourself a chance...it sounds like you're overly stressing yourself out.

I actually think pharmacy school was harder in some aspects than being a pharmacist due to all the bs surrounding the academic world and how you're stuck in a fish bowl with the same classmates day after day. There are days when being a pharmacist can be stressful, but I'm way more calmer now than I was during school. N = 1.

Let's make this N=2 because I absolutely agree. It's funny when you look back years later, or even end up working alongside former professors, and realize they weren't some all-knowing pharmacy guru. In fact, you may find yourself disagreeing with their opinions quite often. The only difference is you are now an equally licensed pharmacist and don't have to listen to them, while a student just has to take it.

 

[Oink]

Could you give examples of the "unprofessional" behavior you exhibited?

The first couple days sounded like they were just giving me an overview and introduction of what Am Care pharmacists do. I didn't know they were teaching me what to do. Basically I forgot some of the stuff they told me during the first couple days. I also forgot that I can say "I don't know, I'll get back to you" when they ask me something that I don't know.

I'm very bad at memorizing. I basically need to write every single thing my preceptor says or else I would forget. I'm scared I would forget that I even wrote those things down. But after my preceptors gave me a talk, I started taking all the notes that I can. I basically wrote everything my preceptor says unless he tells me not to. I just feel bad taking notes all the time because I have to ask my preceptor to slow down or stop for a moment so I can finish writing.

When I reflect back on my first week, it feels like I was a completely different person. I almost want to bang my head on the wall for being that stupid. This reminds me of my first time working at CVS as a pharmacy tech. When I started, it was so bad that I wanted to quit during my lunch break on my first day. I know I was able to stick through CVS, but there's so much more to lose if I fail my rotation. I understand what I should do to improve, but I can't help but worry that I will revert back to my dumb self when I go back to my site.

 

[CYP-0]

Let's make this N=2 because I absolutely agree. It's funny when you look back years later, or even end up working alongside former professors, and realize they weren't some all-knowing pharmacy guru. In fact, you may find yourself disagreeing with their opinions quite often. The only difference is you are know an equally licensed pharmacist and don't have to listen to them, while a student just has to take it.

Already evident with the APPE rotations. There is that sudden disappointment in the icon you have admired for nearly 4 years, followed by a burst of confidence realizing that you don't have to be a walking drug database after all. In the end, we are all humans indeed, with varying gifts.

I'm in my final year of pharmacy school and just started my third rotation. I've always been a calm and relaxed person. I am rarely the type of person to become really stressed and nervous about things. I am horrible at memorizing things, but good with math and numbers. Even when I did bad in some classes, I never really stressed out because I knew I would pass my classes somehow (but end up with a C).

Starting from my last didactic year in pharmacy school, things starting becoming different about my ability to remain calm. For example, I would get nervous whenever I had to present a case in front of a group. It was especially nerve wracking to me when I knew I would have to answer questions on the spot. I hate the fact that I am really bad with memorizing because I'm always thinking stuff like, "dang how do all these people remember these facts??" "How come I can't remember that?" My nervousness even caused me to fail a case presentation for one of my classes, and I was very close to failing the whole class. Luckily, I was able to remediate by passing another case presentation. I always thought I was just being a big baby with all these nervous feelings I've been getting. I kept telling myself to suck it up and be calm the next time. I wasn't like this before, so I hoped that my anxiety wouldn't show in the future.

I did my first two rotations at small independent pharmacies and they went pretty well. All my work experience has been in retail so that is probably why I was comfortable in those rotations. However, I am now in my Am Care rotation and the whole environment is new to me. I just finished my first week of Am Care but I was so nervous that everything went straight out the window. That includes all my knowledge from classes, my ability to think, my professionalism, etc. My preceptors had to give me a lecture, and basically told me that I will fail this rotation if I continue to act like this. After talking to them for a little bit, they basically told me to calm down and work hard. After that lecture, I started working at a slower pace and one of my preceptors said I am starting to improve. However, my embarrassing performance from the first week got me so anxious that I still felt anxious this whole weekend. My head hurts just from thinking about what happened that week. I really don't want to go back to rotations this Monday. I get so nervous when my preceptor asks me to look up stuff because I'm scared of not being able to find any information. One time, my preceptor asked me to look up something about a drug and I couldn't find anything after spending hours on researching the question. I was really confident that there is no information on the question, but I was afraid that possibly I'm just really bad at looking up stuff.

I have been thinking about quitting pharmacy school ever since I started getting these nervous episodes. My first week of Am Care rotation was my worse nervous episode I have experienced ever. I feel really incompetent because I'm definitely not a clinically minded person compared to most of the other students. I am trying so hard to review disease states and drugs related to this rotation, but I feel like I am still dumb compared to everyone else. I really don't know if I can keep this up. What really worries me is that I haven't even had my hardest rotation yet. What if I keep trying and I fail this rotation anyway? My head hurts so much, I feel like my head is in a microwave. I'm assuming having a job as an actual pharmacist would be harder than a student doing their rotations. I keep telling myself I should've went for an easier job. I don't care about making that much money as long as I am happy (or at least okay with my life).

Hey you! Oink! You better buckle up and do whatever you need to do. Try some exercise or something and stop feeling sorry for yourself. You are at the exit door for crying out loud - months away. Have more faith in yourself friend, have more faith!

 

[lord999]

I'm in my final year of pharmacy school and just started my third rotation. I've always been a calm and relaxed person. I am rarely the type of person to become really stressed and nervous about things. I am horrible at memorizing things, but good with math and numbers. Even when I did bad in some classes, I never really stressed out because I knew I would pass my classes somehow (but end up with a C).

Starting from my last didactic year in pharmacy school, things starting becoming different about my ability to remain calm. For example, I would get nervous whenever I had to present a case in front of a group. It was especially nerve wracking to me when I knew I would have to answer questions on the spot. I hate the fact that I am really bad with memorizing because I'm always thinking stuff like, "dang how do all these people remember these facts??" "How come I can't remember that?" My nervousness even caused me to fail a case presentation for one of my classes, and I was very close to failing the whole class. Luckily, I was able to remediate by passing another case presentation. I always thought I was just being a big baby with all these nervous feelings I've been getting. I kept telling myself to suck it up and be calm the next time. I wasn't like this before, so I hoped that my anxiety wouldn't show in the future.

I did my first two rotations at small independent pharmacies and they went pretty well. All my work experience has been in retail so that is probably why I was comfortable in those rotations. However, I am now in my Am Care rotation and the whole environment is new to me. I just finished my first week of Am Care but I was so nervous that everything went straight out the window. That includes all my knowledge from classes, my ability to think, my professionalism, etc. My preceptors had to give me a lecture, and basically told me that I will fail this rotation if I continue to act like this. After talking to them for a little bit, they basically told me to calm down and work hard. After that lecture, I started working at a slower pace and one of my preceptors said I am starting to improve. However, my embarrassing performance from the first week got me so anxious that I still felt anxious this whole weekend. My head hurts just from thinking about what happened that week. I really don't want to go back to rotations this Monday. I get so nervous when my preceptor asks me to look up stuff because I'm scared of not being able to find any information. One time, my preceptor asked me to look up something about a drug and I couldn't find anything after spending hours on researching the question. I was really confident that there is no information on the question, but I was afraid that possibly I'm just really bad at looking up stuff.

I have been thinking about quitting pharmacy school ever since I started getting these nervous episodes. My first week of Am Care rotation was my worse nervous episode I have experienced ever. I feel really incompetent because I'm definitely not a clinically minded person compared to most of the other students. I am trying so hard to review disease states and drugs related to this rotation, but I feel like I am still dumb compared to everyone else. I really don't know if I can keep this up. What really worries me is that I haven't even had my hardest rotation yet. What if I keep trying and I fail this rotation anyway? My head hurts so much, I feel like my head is in a microwave. I'm assuming having a job as an actual pharmacist would be harder than a student doing their rotations. I keep telling myself I should've went for an easier job. I don't care about making that much money as long as I am happy (or at least okay with my life).

Actually, no, the practice gets to be far easier (to the point where I kind of wonder how some of them passed NAPLEX in the first place). You're not the first and not the last to find the internship overwhelming, it's why it's required as a matter of course as the classwork covers only 15% of what you really need to know. The pharmacy schools as of late have been teaching the fiction of clinical pharmacy rather than how to be a pharmacist. In these rotations, it is the goal to fill in the gaps and ensure that you leave the university knowing how to be a pharmacist. This demands a very different level of cognition and action than the passive learning experience. It's why I recommend every single pharmacy student to work as well as attend classes, for most, work at least complements and in very good cases, is superior to what we can train you in the lecture hall.

Based on your own narration, I think I would agree with the preceptor that you have performance anxiety rather than incompetence at this point. There's some things you can work on yourself, even while you are in the rotation:

1. Work on your "professional" presentation and demeanor. What I want you to do is either through your phone or with a webcam, take out either your DiPiro or Koda Kimble (or whatever you use for pharmacotherapy), turn the camera on so that it faces you, and calmly read the chapter out loud, taking care to pronounce every drug correctly and every circumstance as if you were reading this in front of a lectern with deliberate and calm demeanor (wish I could send you something from my alma mater where my pharmacologist, Joie Rowles, has that down pat). Once you record yourself, save the video. Now, turn on that video on a screen, and watch yourself read that chapter out loud. That's you! Not the flighty scatterbrain, but what you want to be. Because this is AmCare, I recommend you start with cardiac. That means hypertension, lipids, diabetes, post-thrombic incident care, arrhythmia, and CHF (in that order as one leads to another) and then thyroid, diabetes (kind of a capstone endocrine), asthma, and finally epilepsy. Every night for the next week, narrate another, and then watch the old videos and the new one you made. It'll take a week, but I think you'll see a noticeable improvement in both your bearing and your associations. It's important that you don't cheat and skip, be methodical and read.

2. Don't be afraid to say, "I don't know today, but I'll know tomorrow." It's better not to say something stupid and impulsive. If a preceptor chews you out saying that "the patient is here today", reply pointedly that "I am also a student today, and a wrong answer to a patient today may not be correctable tomorrow." This is AmCare, not ICU, and methody deliberation is possible. That means, you'll always have homework.

3. On your own time, and somewhat immediately, I would ask that you find one of the medical librarians (either at the site you are practicing at or your university), and request a personal rundown on the following resources:
1. Micromedex (more or less mandated in the institutional setting) - Inclusive of dosing and industry studies areas on the monograph
2. Your university's journal access and be able to comfortably access NEJM, JAMA, AIM, JASHP, JAPhA, and Pharmacotherapy
3. Whatever pharmacotherapy resources you also have (Lexi is the most common and it's the one I recommend)
4. OTC guide (I recommend the Pray book if your university didn't train you on the subject)

 

[PikminOC]

 

[PikminOC]

 

[PikminOC]

 

[Digsbe]

You'll get through it, trust me. I felt the same way on a clinical rotation I had. It required me to be at the hospital by 630am (so I was waking up at 4am and sleep deprived), it was a fairly intimidating environment and anytime I thought I had worked up a patient perfectly my preceptor would find something else or ask me a question I didn't know. I felt nervous, felt like I couldn't do anything right... around week 2 I had most things sorted and went on to make an A on the rotation. Everyone has those moments, you'll get through it!

 

[Chriskahn]

Propranolol perhaps?

 

[Oink]

Well I'm getting through my second week now and I am getting used to the work flow... The problem I'm still having is when they quiz me on things. My preceptor said he's getting prepared to grill me later on this week or next week.

The positive right now is that I feel like I'm learning. But I also feel like the stress hinders me from being efficient. At least the stress keeps me awake during rotations... I'm already tired from working 10-11 hour days. I am really not looking forward to my next rotation which has students work like 12-14 hour days..

 

[trailerpark]

Get rxprep and go through the major disease states. It's a great resource for APPEs


Sent from my iPhone using SDN mobile app

 

[CYP-0]

Get rxprep and go through the major disease states. It's a great resource for APPEs

Ditto. If you have access to the lecture videos...and time, it makes the reading a lot more faster and easier to retain. At least, it does for me and some of my colleagues.

I'm already tired from working 10-11 hour days. I am really not looking forward to my next rotation which has students work like 12-14 hour days..

Say whaaaa...??? There are rotations that keep students for more than 8 hours?!

 

[ldiot]

You'll make it through. I work as an intern and realized when I'm talking to real patients in the pharmacy at work I'm not nervous at all, but when I'm on a school rotation with a preceptor looking over my shoulder it's a different ballgame. We also have mock patient counseling that they video record and I almost have a heart attack every single time right before I enter the room. In my opinion school related stuff is just unnecessarily stressful; you just have to do your best and grind it out, you are almost to the finish line.

 

[Oink]

Get rxprep and go through the major disease states. It's a great resource for APPEs


Sent from my iPhone using SDN mobile app

Yeah the Rxprep book is helping a lot with disease states. What takes me a while to understand for certain disease states is WHY certain drugs are used. It's slow but I feel like I'm starting to understand more and more....

I've also been looking at youtube videos for disease states. It may or may not be the best source of information, but the videos are simple enough as a starting point to help me learn some things.

Ditto. If you have access to the lecture videos...and time, it makes the reading a lot more faster and easier to retain. At least, it does for me and some of my colleagues.


Say whaaaa...??? There are rotations that keep students for more than 8 hours?!

Well technically they tell me "9-5".. but I have to SOAP up as many patients as I can for the day. 8 hours has not been enough time for us to finish all the patients, so my preceptor said it is "recommended" to come earlier and then stay until all work is finished. But my preceptor "recommending" me to come early feels more like an expectation because he does the same thing too. It kind of sucks because it doesn't seem like he gets paid for those extra hours.

The 12-14 hour rotation is going to be my acute care rotation. I think other people may call it their medicine rotation. But yeah, I hear some of my friends going in at 6AM and then coming home at around 8PM.

 

[ldiot]

I was just wondering, since I've never done a real SOAP note, is the SOAP note completed on the spot as you are talking to the patient or do you get the information that you need from the patient and type up the note in an office afterwards?

I know we had to do a few SOAP notes for one of my classes (the information was given to us) and honestly it took me like 30 minutes or more. I always wondered if you are supposed to be exiting the patient's room with a finished product or if this is done between patients.

 

[gwarm01]

Yeah the Rxprep book is helping a lot with disease states. What takes me a while to understand for certain disease states is WHY certain drugs are used. It's slow but I feel like I'm starting to understand more and more....

I've also been looking at youtube videos for disease states. It may or may not be the best source of information, but the videos are simple enough as a starting point to help me learn some things.



Well technically they tell me "9-5".. but I have to SOAP up as many patients as I can for the day. 8 hours has not been enough time for us to finish all the patients, so my preceptor said it is "recommended" to come earlier and then stay until all work is finished. But my preceptor "recommending" me to come early feels more like an expectation because he does the same thing too. It kind of sucks because it doesn't seem like he gets paid for those extra hours.

The 12-14 hour rotation is going to be my acute care rotation. I think other people may call it their medicine rotation. But yeah, I hear some of my friends going in at 6AM and then coming home at around 8PM.

Anyone who works off the clock without pay is a sucker. That's the lesson you can take away from this rotation.

 

[lord999]

I was just wondering, since I've never done a real SOAP note, is the SOAP note completed on the spot as you are talking to the patient or do you get the information that you need from the patient and type up the note in an office afterwards?

I know we had to do a few SOAP notes for one of my classes (the information was given to us) and honestly it took me like 30 minutes or more. I always wondered if you are supposed to be exiting the patient's room with a finished product or if this is done between patients.

It'll honestly take you that long at the start. Unless this is a comprehensive review (I mean the JC Nursing Home Care review notes due monthly), you'll be able to crank them out in 10 mins and possibly less (and it's bad form and practice to write in front of a patient that's not direct data collection). If this is not an intake or discharge note or the above-mentioned review note and you're exceeding 500 words, you're not being precise enough in the majority of cases or you are correcting someone else's screwup.

You'll pick up some template patterns and form language that speeds this up (like I expect every hypertension note to be relatively the same every time I write one), same even with more complex matters unless again I'm fixing someone else's mistake. It's a practice matter.

Anyone who works off the clock without pay is a sucker. That's the lesson you can take away from this rotation.

Unless it's to get paid in the first place. Trust me, most of us hate writing notes, but if you're in a chargemaster situation, you better do at least enough for business compliance (and that means different things to different people, just make sure you get #*@$ing paid). What I find irritating is when someone writes a 2000 word bore that could have been summarized in 250, and worse, does not justify the diagnostic and procedural criteria necessary for the chargemaster. If we do our jobs properly, we template those standard conditions such that the standard notes write themselves and the only thing the practitioner needs to fill in are the immediate numbers and changes.

 

[sakigt]

My first rotation was amb care at a academic hospital. After the first week I basically compared notes to to the other students on various rotations and decided I wasn't doing enough to prepare for that particular rotation. I had a good meltdown in the shower, picked myself up and just got through it.

They told me 9-5 but it was basically 730-5 with evenings and weekends filled with baloney.

 

[sakigt]

I was just wondering, since I've never done a real SOAP note, is the SOAP note completed on the spot as you are talking to the patient or do you get the information that you need from the patient and type up the note in an office afterwards?

I know we had to do a few SOAP notes for one of my classes (the information was given to us) and honestly it took me like 30 minutes or more. I always wondered if you are supposed to be exiting the patient's room with a finished product or if this is done between patients.

Until you get the hang of it youre going to have to old fashioned pen to paper then type it all up. Once you ask the same questions over and over youll get the hang of typing while talking and making eye contact as much as possible between gaps, then rereading and adjusting afterwards

 

[CYP-0]

Well, for my acute care/internal med rotation, it was at an oncology unit/site. My partner and I were scheduled to resume at 9 every morning, but we showed up at 7am (on the average) to work up patients.

A fashion that proved more efficient for us was to document (with pen & paper) the patient's demographics, allergies, and subjective (ER/triage) data first before we visited the med reconciliation list. The MAR was next, and pretty much were we spent the bulk of our time. We had to find a rationale behind every medication activity on their MAR, including new and d/c'd rx orders. In doing so, we were systematically forced to reference relevant lab values, radiology reports, and other info we needed to fill the remaining components of our work-up sheets. Then at 9am, sometimes 10, we rounded with the oncologist and had to update our sheets with new developments/changes on the floor.

After the rounds, we had the rest of the shift to work on typed SOAP notes using our work-up sheets. We were allowed to go home with our (HIPPA-compliant) work-up sheets as well. Hence, we never had to stay beyond 8 hours. But we had to meet twice per week on campus to present those SOAP notes alongside disease state discussions and quizzes.

 

[CetiAlphaFive]

Anyone who works off the clock without pay is a sucker. That's the lesson you can take away from this rotation.

It always cracks me up to hear wage-slaves say this.

Whatever happened to taking pride in what you do and doing it to the best of your ability

 

[gwarm01]

It always cracks me up to hear wage-slaves say this.

Whatever happened to taking pride in what you do and doing it to the best of your ability

I guess I should elaborate on my position since I made a sort of drive-by post.

I'm in a salaried position at the moment. I'll come in early, I'll stay late, I will do whatever is needed to make sure our projects are successful. I don't complain because that's the expectation of a salaried position, but it also comes with the benefit of being able to take off early or leave the office for a few hours if I have an appointment. It's a fair trade-off.

However, if you are an hourly employee working for an organization and the expectation is that you work unpaid hours to complete the job then you are not taking pride in your work. You are enabling your employer to take advantage of you. Not to mention it can be illegal depending on your state, and that you better believe your employer will not defend you if you make an off the clock mistake that leads to litigation.

If you are paid for eight hours of work but the job requires ten hours of labor, it's time to revaluate your staffing model. In a previous life I was working an hourly position in oncology with a small team. The hospital had grown tremendously in a short period of time and the oncology department had more than doubled their daily admissions. New oncologists, nurses, and nurse practitioners were hired to handle the increased workload, but we maintained the same level of pharmacists. Our head pharmacist had a bad habit of working 14 hour days, every day, just to get everything finished. Clockout after 10 hours, then often stay working until midnight. Long story short, we weren't able to get the pharmacy director to address staffing until everyone on the team agreed to remain on the clock. The massive increase in overtime forced management to address the fact that we were severely understaffed AND led to my friend getting a promotion.

To the original student, obviously you don't have any choice now.. but remember to have respect for your time and your value when you are licensed. This is your career and you are not a charity (unless you want to volunteer in your private time of course)!

 

[holymolys]

I found some rotations and schooling to be more difficult as well, it was so damn clinical and detailed for no reason. I coasted through my rotation year with bare minimal effort, goal was passing, my favorites were the retail slavery rotations where I just do their tech's work all day. Later I landed a staffing job in a hospital (exactly as I planned), and I found out clinically I was starting over at 0 anyway, just like any other new grad new hire they had. I assumed they were much better students than I was, but rotations are just rotations, you might learn some new info but it can't possibly cover everything.

From time to time I get asked the most ridiculous clinical questions by prescribers, and it can be slightly nerve wracking when you have no clue wtf they are talking about or how to help them, and it's much more intense when they are waiting on the phone for an answer. Generally 95% of the questions can be answered via lexicomp/google, but theres always a 5% chance you'll just sound like an idiot for not knowing/finding something you feel like you should know, and you just have to accept that, and say you don't know in the most professional manner and bull**** them. Think of it this way, they called me because they didn't know either, so maybe it's just really hard to research!

 

[ldiot]

Well, for my acute care/internal med rotation, it was at an oncology unit/site. My partner and I were scheduled to resume at 9 every morning, but we showed up at 7am (on the average) to work up patients.

A fashion that proved more efficient for us was to document (with pen & paper) the patient's demographics, allergies, and subjective (ER/triage) data first before we visited the med reconciliation list. The MAR was next, and pretty much were we spent the bulk of our time. We had to find a rationale behind every medication activity on their MAR, including new and d/c'd rx orders. In doing so, we were systematically forced to reference relevant lab values, radiology reports, and other info we needed to fill the remaining components of our work-up sheets. Then at 9am, sometimes 10, we rounded with the oncologist and had to update our sheets with new developments/changes on the floor.

After the rounds, we had the rest of the shift to work on typed SOAP notes using our work-up sheets. We were allowed to go home with our (HIPPA-compliant) work-up sheets as well. Hence, we never had to stay beyond 8 hours. But we had to meet twice per week on campus to present those SOAP notes alongside disease state discussions and quizzes.

Do the physicians actually take into consideration your SOAP note? How often was your plan utilized? I'll be honestly aside from the P in the SOAP it sounds like a lot of data collection and record keeping which I think would get boring.

 

[lord999]

Do the physicians actually take into consideration your SOAP note? How often was your plan utilized? I'll be honestly aside from the P in the SOAP it sounds like a lot of data collection and record keeping which I think would get boring.

They may, but even clinical pharmacist notes are not necessarily read as providers do not necessarily read each others notes to begin with. So, have you asked why you write these notes in the first place if no one reads them?

There's actually an answer. The entirety of the note IF you are in the private sector is to help the HIMS staff pull out the right codes and such for billing. In the outpatient setting, this is basically the CPT's but ALSO the ICD's that justify those procedures. In the inpatient setting, it's used by the chargemaster and HIMS staff to build the DRG profiles and extraneous CPT's necessary for the billing (the facility versus the professional part). This all assumes that you are billing a third party and your hospital isn't funding care itself. The note has to defend later on what ICD and CPT codes (or the DRG profiles) are chosen from a business compliance standpoint. Only as a secondary matter should a note be readable by another practitioner. It's nice, but if you're writing in a way to pass business compliance, a readable note is assumed by licensed independent providers.

By the way, that "licensed independent providers" concept is a real one. Pharmacists are not LIPs, so insurance will not look at their notes or give them credence for counting toward the DRG profiles. We are always counted as part of the facility for reasons having to do with our product billing basis. So, when you write a note, you're basically following the cargo cult of clinical pharmacy thinking if I imitate others who write notes, the same sorts of compensation will show up. But since we don't actually do this for the right reasons (to get paid), notes are just a quaint thing that pharmacists do.

There are two exceptions:
1. The medication review requirement for Joint Commission which CMS actually counts as part of a skilled nursing facility fee (and is paid to the pharmacist as part of that requirement usually through a contracted basis).
2. DME consults that result are billable through A or B depending on the rules

In a first-party payer situation (like the VA), no note ANYONE writes means anything whatsoever to the internal processes of how medical centers get funded. The way HHS and VA does it, we use a patient-capitation model (called VERA/ARC in the VA, or ICARE in the IHS) to allocate funding based on the encounter CPT's and hospitalization DRG's that show up. We do not read notes at all, and we get away with much laxer documentation than the private sector. That's because there are no appreciable HIMS staff in the federal system, providers do their own coding (which pisses them off if they came from the private sector), but since coding doesn't matter for payment, there is a much lower investment in HIMS staff to provider ratio. VA's trying to get better at it to try to do 3rd party recovery through Care Collections, but the national reimbursement in total from that billing does not equal a month's worth of pharmaceuticals for a region (VISN) anywhere and is considered trivial by the budgeting department. There's games we play for those first party dollars, and that's a conversation for the management.

(But if you want to know one of the many reasons why care coordination between specialists and primary care or the hospitalists suck in the VA, because specialists know that their notes aren't held to business compliance standards, they get away with writing absolute garbage or not even bothering to even encounter leaving the primary care/hospitalist service in the lurch.)

 

[Oink]

I was just wondering, since I've never done a real SOAP note, is the SOAP note completed on the spot as you are talking to the patient or do you get the information that you need from the patient and type up the note in an office afterwards?

I know we had to do a few SOAP notes for one of my classes (the information was given to us) and honestly it took me like 30 minutes or more. I always wondered if you are supposed to be exiting the patient's room with a finished product or if this is done between patients.

For me, I have to complete and present my SOAPs to my pharmacist before talking to the patient. So far my pharmacist just splits to patients between the both of us, or I just tell the pharmacist who I am going to SOAP. If my pharmacist agrees with what I'm going to do, then they just let me go and talk to the patient. If he doesn't agree with me, then we talk it out and I go talk to my patient after we reached an agreement to their therapy.

We had some classes where we mostly practice SOAPs too. It would take me about an hour or so just to SOAP one patient, but usually that patient has multiple problems to deal with. Many pharmacists I talked to have told me that the SOAPs we do in class is nothing like in real life. It's supposed to be shorter, but more concise. I'm starting to SOAP each patient a little more quickly now. It is almost like repetition. But I'm always paranoid that I am doing it too fast so I always spend at least 15 minutes per patient SOAP. If it is a complicated SOAP, then I would take about 30 minutes for that patient.

 

[ldiot]

They may, but even clinical pharmacist notes are not necessarily read as providers do not necessarily read each others notes to begin with. So, have you asked why you write these notes in the first place if no one reads them?

There's actually an answer. The entirety of the note IF you are in the private sector is to help the HIMS staff pull out the right codes and such for billing. In the outpatient setting, this is basically the CPT's but ALSO the ICD's that justify those procedures. In the inpatient setting, it's used by the chargemaster and HIMS staff to build the DRG profiles and extraneous CPT's necessary for the billing (the facility versus the professional part). This all assumes that you are billing a third party and your hospital isn't funding care itself. The note has to defend later on what ICD and CPT codes (or the DRG profiles) are chosen from a business compliance standpoint. Only as a secondary matter should a note be readable by another practitioner. It's nice, but if you're writing in a way to pass business compliance, a readable note is assumed by licensed independent providers.

By the way, that "licensed independent providers" concept is a real one. Pharmacists are not LIPs, so insurance will not look at their notes or give them credence for counting toward the DRG profiles. We are always counted as part of the facility for reasons having to do with our product billing basis. So, when you write a note, you're basically following the cargo cult of clinical pharmacy thinking if I imitate others who write notes, the same sorts of compensation will show up. But since we don't actually do this for the right reasons (to get paid), notes are just a quaint thing that pharmacists do.

There are two exceptions:
1. The medication review requirement for Joint Commission which CMS actually counts as part of a skilled nursing facility fee (and is paid to the pharmacist as part of that requirement usually through a contracted basis).
2. DME consults that result are billable through A or B depending on the rules

In a first-party payer situation (like the VA), no note ANYONE writes means anything whatsoever to the internal processes of how medical centers get funded. The way HHS and VA does it, we use a patient-capitation model (called VERA/ARC in the VA, or ICARE in the IHS) to allocate funding based on the encounter CPT's and hospitalization DRG's that show up. We do not read notes at all, and we get away with much laxer documentation than the private sector. That's because there are no appreciable HIMS staff in the federal system, providers do their own coding (which pisses them off if they came from the private sector), but since coding doesn't matter for payment, there is a much lower investment in HIMS staff to provider ratio. VA's trying to get better at it to try to do 3rd party recovery through Care Collections, but the national reimbursement in total from that billing does not equal a month's worth of pharmaceuticals for a region (VISN) anywhere and is considered trivial by the budgeting department. There's games we play for those first party dollars, and that's a conversation for the management.

(But if you want to know one of the many reasons why care coordination between specialists and primary care or the hospitalists suck in the VA, because specialists know that their notes aren't held to business compliance standards, they get away with writing absolute garbage or not even bothering to even encounter leaving the primary care/hospitalist service in the lurch.)

In other words if yoi are looking at the big picture physicians write SOAPS for billing and since pharmacist notes can't be used for billing it's just pointless

 

[BidingMyTime]

Pretty much everyone is stressed out by new work environments, but the level of stress you are experiencing seems more than what the average person would experience.I would recommend talking to a psychologist/psychologist--they can help you work on coping techniques and/or prescribe medication if they deem it necessary.

 

[Oink]

Hi everyone. An update with my dilemma. So I am getting the feeling that my preceptor just doesn't like me. There is some feedback that he gives me once in a while, but I really don't feel like it is constructive feedback anymore. It is getting to the point where I feel like it's insulting or condescending. Here is a list of examples:

1) He says I sound too quiet on the phone and I need to start speaking in a way where elder people can hear better. I believe this is a very reasonable suggestion. But he would literally start talking for 5 minutes straight about how he doesn't like how I speak. Then he starts mimicking the way I speak, which I felt was very unnecessary.

2) He would also mimic my facial expressions and the way I ask questions. He says I always have a "surprised" look when I talk to him. When I think about it, that is just how my face is. I naturally have my eyes wide opened when I'm thinking or actively listening. But mimicking my facial expressions was unnecessary in my opinion too. Also, he mimics the way I ask questions with a little baby voice too. He's not saying I sound like a baby when I ask questions, but he gets mad at me when I try to clarify something. I would literally ask something such as "Oh just making sure, so you want my project to be like this and this and this." He would answer it nicely at the moment, but would bash me at the end of the day saying I should not be asking those questions.

3) He then started to insult me on my ability to work at my other job. I work at an independent pharmacy, but I work there pretty rarely (probably once every other week and I was hired about 5 months ago). So sometimes I would have normal conversations with him about my other job. I would tell him what stuff I do, and stuff I haven't done at the pharmacy yet. Since I told him there are things about the pharmacy I haven't learned yet, he completely just bashed me by saying that I have no motivation to learn and find things out on my own. He would also continue insulting me by asking me things such as, "you probably don't know many things about your pharmacy huh?" or "do you just not care about your pharmacy to not learn things you don't know?"

4) Then he adds on more to my apparent lack of motivation. He says I don't try to learn things outside of my rotation which is completely false. I always review material outside of APPEs because I believe I need a lot of review to keep up. However, sometimes I don't know the answers to some questions he asks. For example, he asks a question about a disease state that was seen in a patient. So I say, "I don't know at the moment, but I'll look it up and get back to you." But he would say, "No, tell me what you think." So I give him an answer which I know is wrong. Then, I look it up and then I tell him what I looked up, and all he cares about is the fact that I was wrong in the first place and I am going to kill a patient because I didn't know the answer beforehand. He also says that I should've looked up the disease state before he asked me. How was I supposed to know he would ask me about that disease state? Even if I did look it up on my own, he would end up getting mad at me for taking too much time. I thought I was allowed to tell him that I would look it up if I didn't know the answer. Anyways, I ended up telling him that I do look up stuff on my own when things come across my way, and I just don't tell my preceptor because it is information that I just wanted to learn for myself. But he doesn't care and just insists that he doesn't see my point of view.

5) He also gives me very conflicting feedback. On the second week of rotations, he says I'm improving a lot. But the past few days he says I'm working as if I am working my first day here. He still says my SOAPs are good and my drug plan for my patients are good. So what does that even mean? He says I'm improving, but I haven't progressed since day 1?

6) Part of his feedback was saying that "my head is not right and I have no idea how to fix it." ... which is also not very helpful.

There's more things he did that felt insulting, but I can't think of it right now. During the first 2 weeks of rotations, I thought I just need to suck it up and take his feedback. But now that I think about it, there is nothing about his feedback that I would actually consider as advice. He basically is saying that I am too slow and don't care about learning. I've actually learned a lot the past few weeks, but that is because I've independently studied outside of my APPEs.

I feel like I have no idea what he wants from me. Criticizing me about my other job and getting mad at me for clarifying things has made it really hard for me to approach him. I am absolutely trying my hardest understanding him but everything he has told me has been inconsistent and very unhelpful. According to his evaluation, I am about to fail this rotation and it has nothing to do with my ability to work with patients. He says I'm good with the patients and their drug plan, but I just need to do them faster (which is something I can definitely do right away).

 

[Sine Cura]

Your preceptor sounds like someone butthurt about not becoming a physician.

 

[lord999]

Hi everyone. An update with my dilemma. So I am getting the feeling that my preceptor just doesn't like me. There is some feedback that he gives me once in a while, but I really don't feel like it is constructive feedback anymore. It is getting to the point where I feel like it's insulting or condescending. Here is a list of examples:

1) He says I sound too quiet on the phone and I need to start speaking in a way where elder people can hear better. I believe this is a very reasonable suggestion. But he would literally start talking for 5 minutes straight about how he doesn't like how I speak. Then he starts mimicking the way I speak, which I felt was very unnecessary.

2) He would also mimic my facial expressions and the way I ask questions. He says I always have a "surprised" look when I talk to him. When I think about it, that is just how my face is. I naturally have my eyes wide opened when I'm thinking or actively listening. But mimicking my facial expressions was unnecessary in my opinion too. Also, he mimics the way I ask questions with a little baby voice too. He's not saying I sound like a baby when I ask questions, but he gets mad at me when I try to clarify something. I would literally ask something such as "Oh just making sure, so you want my project to be like this and this and this." He would answer it nicely at the moment, but would bash me at the end of the day saying I should not be asking those questions.

3) He then started to insult me on my ability to work at my other job. I work at an independent pharmacy, but I work there pretty rarely (probably once every other week and I was hired about 5 months ago). So sometimes I would have normal conversations with him about my other job. I would tell him what stuff I do, and stuff I haven't done at the pharmacy yet. Since I told him there are things about the pharmacy I haven't learned yet, he completely just bashed me by saying that I have no motivation to learn and find things out on my own. He would also continue insulting me by asking me things such as, "you probably don't know many things about your pharmacy huh?" or "do you just not care about your pharmacy to not learn things you don't know?"

4) Then he adds on more to my apparent lack of motivation. He says I don't try to learn things outside of my rotation which is completely false. I always review material outside of APPEs because I believe I need a lot of review to keep up. However, sometimes I don't know the answers to some questions he asks. For example, he asks a question about a disease state that was seen in a patient. So I say, "I don't know at the moment, but I'll look it up and get back to you." But he would say, "No, tell me what you think." So I give him an answer which I know is wrong. Then, I look it up and then I tell him what I looked up, and all he cares about is the fact that I was wrong in the first place and I am going to kill a patient because I didn't know the answer beforehand. He also says that I should've looked up the disease state before he asked me. How was I supposed to know he would ask me about that disease state? Even if I did look it up on my own, he would end up getting mad at me for taking too much time. I thought I was allowed to tell him that I would look it up if I didn't know the answer. Anyways, I ended up telling him that I do look up stuff on my own when things come across my way, and I just don't tell my preceptor because it is information that I just wanted to learn for myself. But he doesn't care and just insists that he doesn't see my point of view.

5) He also gives me very conflicting feedback. On the second week of rotations, he says I'm improving a lot. But the past few days he says I'm working as if I am working my first day here. He still says my SOAPs are good and my drug plan for my patients are good. So what does that even mean? He says I'm improving, but I haven't progressed since day 1?

6) Part of his feedback was saying that "my head is not right and I have no idea how to fix it." ... which is also not very helpful.

There's more things he did that felt insulting, but I can't think of it right now. During the first 2 weeks of rotations, I thought I just need to suck it up and take his feedback. But now that I think about it, there is nothing about his feedback that I would actually consider as advice. He basically is saying that I am too slow and don't care about learning. I've actually learned a lot the past few weeks, but that is because I've independently studied outside of my APPEs.

I feel like I have no idea what he wants from me. Criticizing me about my other job and getting mad at me for clarifying things has made it really hard for me to approach him. I am absolutely trying my hardest understanding him but everything he has told me has been inconsistent and very unhelpful. According to his evaluation, I am about to fail this rotation and it has nothing to do with my ability to work with patients. He says I'm good with the patients and their drug plan, but I just need to do them faster (which is something I can definitely do right away).

You need to bring this back to your university's experiential education coordinator. If this is true, this is inappropriate conduct on the part of the preceptor. The Hollywood good ole days of having a pimping openly abusive chief of service went away a decade ago after Yale and JHU got the death penalty for over the top behavior. In this era, there's appropriate ways to present feedback to problem interns (and even downright incompetent ones). This crosses into positional abuse.

 

[CYP-0]

You need to bring this back to your university's experiential education coordinator. If this is true, this is inappropriate conduct on the part of the preceptor. The Hollywood good ole days of having a pimping openly abusive chief of service went away a decade ago after Yale and JHU got the death penalty for over the top behavior. In this era, there's appropriate ways to present feedback to problem interns (and even downright incompetent ones). This crosses into positional abuse.

Agreed, 100%. The level of the preceptor's lack of professionalism is through the roof, and that alone disqualifies him from being one.

Oink, I don't know how many more weeks you have with him, but I would have requested for a site change, while reporting him.

 

[Oink]

I spoke to my experiential coordinator yesterday and she believed we have to see if I can change anything about myself first before blaming it on the preceptor. Things I may need to work on is anticipating follow-up questions from my preceptor and proving that I am motivated...

Does anyone have any advice on how to do that? I feel like I run into things that I don't think of looking up.. so when my preceptor asks me those things, he basically makes me look like a fool. I always thought replying with "I don't know, I'll follow up with you on that" is an appropriate answer... This whole rotation so far has made me feel so stupid and I feel like everything that I do is wrong.

I guess it sounds reasonable to give it one more try but I'm so depressed now with my situation. I have never had to deal with this before. I thought I've been trying so hard already, but now I can't find the energy to give it an extra push. I feel like I have to become a completely new person in the next few weeks in order to pass....

 

[Oink]

Okay I really feel like I'm gonna fail now... I couldn't answer any of my preceptor's questions today and now I have a zillion things to look up. Not only do I feel dumb, I'm not as fast as I thought I was... I worked a little more quickly this time, and I really felt like I was working quicker too. But even after working quicker, I still couldn't reach my goal of the number of patients I need to SOAP. I was really close though so I guess that's a good thing, but I thought I would be a lot faster than I was today..

Does anyone know what happens to people when they fail their rotation?..

 

[ldiot]

Your preceptor sounds like a jackass, especially considering that fact that your are literally providing free labor for him. It's perfectly reasonable for a preceptor to set high expectations and expect students to work hard but it sounds like this guy isn't at all interested in your education or helping you improve.

Has anyone else you know had this preceptor? Maybe he will pass you and is just an ass. I think it would be pretty hard to fail a student unless they were unprofessional, lazy, or incompetent. Sounds to be like there has been no issues with your SOAP notes which I would assume is a descent measure of your competency.

 

[Oink]

Someone two years ago had this rotation. He said he did well in this rotation, but he really likes Am Care. I don't really like Am Care that much, but I'm trying my ass off. I literally got bashed yesterday because my preceptor said to me, "you don't seem to know anything and that is a problem." The only advice he would give me is that I need to figure it out on my own.

I'm really scared im going to fail. The only thing that I got better at is the speed, but my preceptor said literally anybody can do what I am doing now.

What am I supposed to do better? How do I show that I learned? Or at least, how do I show that I want to learn? I literally don't feel like I learned anything because I'm literally just working up patients and not being taught anything.

 

[Oink]

Sorry for double posting, but I have another question. If my preceptor gave me a list of things I have to do to pass, is he allowed to fail me for anything else that is not listed? He basically told me that in order to pass, I need to be able to finish all my patient work ups each day, finish all my projects, and show that I am trying hard to learn. The problem is that my preceptor keeps telling me that I know nothing and that he doesn't know what to do with me. He's making it seem like it's something he's really worried about and I'm afraid he's gonna fail me because of that.

I am almost done with this rotation, but I get even more nervous each day I work with him. I am trying so hard to learn by studying on my own at home, but he crushes my confidence by lecturing me every day for about 30-60 minutes on why he thinks I know nothing. I'm seriously learning nothing because he's so negative towards me and none of his feedback is constructive.

I'm afraid he has been having this preconceived idea during this whole rotation that I am incompetent and will fail me just because of that. I've never dealt with this situation before. I've never had anyone make me feel incompetent to the point where I doubt everything in my mind. I feel like he can twist it in a way by saying that I didn't try to learn and that is why I don't know anything. But I honestly believe that it is just impossible for me to work with this preceptor and I cannot ever figure what he wants from me.

I've been going up to all the pharmacist at the hospital for advice. Some of them help, some of them not really.

 

[DRHRT]

u've come this far. Don't give up now! You can do it!! All the hard work will be worth it & believe me pharmacy school n rotations are much harder than the real thing!!! Just be positive, u've come so far!!!

 

[Oink]

Thank you guys for the encouragement. I just wonder if he will fail me for something that is not on his list of things I need to do to pass. I'm not trying to do the bare minimum but it's really hard to get a sense of how I'm doing in this rotation..

 

[lord999]

Sorry for double posting, but I have another question. If my preceptor gave me a list of things I have to do to pass, is he allowed to fail me for anything else that is not listed? He basically told me that in order to pass, I need to be able to finish all my patient work ups each day, finish all my projects, and show that I am trying hard to learn.

Yes, actually. I hate to be negative at this point, but I think you should have requested reassignment earlier than this. I think he has come to a conclusion to fail you at this point irrespective of effort.

For non-behavioral reasons, I have failed interns for non-performance before. However, the way I have done this is to have another preceptor jointly have them for a week or two (four weeks is the minimum rotation) and see if they come to the same conclusion. I usually direct the experiential education committee (if not my university) to force the intern to take PARE if it really is a competency matter (at this point in the process, the intern should easily pass PARE). PARE is specifically written to be far easier than NAPLEX, so I feel comfortable with issuing a fail with concurrence but use the exam results and feedback from the other preceptor in the writeup.

However, in the two cases this has happened, I brought in the experiential education coordinator at the midterm to say that this intern is performing beneath passable expectations and failure is a high risk at this point. So, I did it by the book. In one case, the intern never got licensed (failed three other rotations and would not repeat the third year), in the other, the intern shaped up and did better on a different rotation and is a CVS pharmacist now.

 

[Oink]

Sigh... that's what I was afraid of. I feel like I'm literally back to square 1. Back to being extremely anxious and nervous at my APPEs. I've done everything my preceptor wants from his list of things to pass. The number of patients I finish per day is now well exceeded past his minimum. Although his criteria of "trying hard to learn" could be subjective. I could try as hard as I want but he may not believe me.

It's really frustrating now because I think the work they have given me is pretty easy at this point. It's just really hard for me to work with my preceptor when all he does is criticize me without giving me any type of constructive feedback..

 

[lord999]

Sigh... that's what I was afraid of. I feel like I'm literally back to square 1. Back to being extremely anxious and nervous at my APPEs. I've done everything my preceptor wants from his list of things to pass. The number of patients I finish per day is now well exceeded past his minimum. Although his criteria of "trying hard to learn" could be subjective. I could try as hard as I want but he may not believe me.

It's really frustrating now because I think the work they have given me is pretty easy at this point. It's just really hard for me to work with my preceptor when all he does is criticize me without giving me any type of constructive feedback..

If I were you, just focus on doing what you can at this point in terms of self-improvement, BUT, you *learned* a lesson the hard way on how much a supervisor can string you along and screw you over. You need to be wary and cognizant of these sorts of sociopaths and avoid them. My very first job as a pharmacist, I actually worked for someone like the preceptor that you described at the University. A lot of my practice neuroses can be traced back to that person, and it's well-known in the state that I go out of my way to screw his company over every chance I get. Oddly enough, when I came back as faculty, let's just say what goes around comes around. Although, I would also say that the rest of the faculty probably wishes I were treated better back in the day. I always remark to my classes that it's likely that I'll train both my successor and my boss in school, but as I don't know who they are yet, it's best to be professional at least (and even with the two fails, they were clearly communicated even though it wasn't easy on either of us).

Don't let this get you down. You did you best considering you had an adverse environment.

 

[Oink]

If I were you, just focus on doing what you can at this point in terms of self-improvement, BUT, you *learned* a lesson the hard way on how much a supervisor can string you along and screw you over. You need to be wary and cognizant of these sorts of sociopaths and avoid them. My very first job as a pharmacist, I actually worked for someone like the preceptor that you described at the University. A lot of my practice neuroses can be traced back to that person, and it's well-known in the state that I go out of my way to screw his company over every chance I get. Oddly enough, when I came back as faculty, let's just say what goes around comes around. Although, I would also say that the rest of the faculty probably wishes I were treated better back in the day. I always remark to my classes that it's likely that I'll train both my successor and my boss in school, but as I don't know who they are yet, it's best to be professional at least (and even with the two fails, they were clearly communicated even though it wasn't easy on either of us).

Don't let this get you down. You did you best considering you had an adverse environment.

What were specific examples of why you failed your students? Were they not able to do the work? Did they just not know certain knowledge?

 

[CetiAlphaFive]

Sigh... that's what I was afraid of. I feel like I'm literally back to square 1. Back to being extremely anxious and nervous at my APPEs. I've done everything my preceptor wants from his list of things to pass. The number of patients I finish per day is now well exceeded past his minimum. Although his criteria of "trying hard to learn" could be subjective. I could try as hard as I want but he may not believe me.

It's really frustrating now because I think the work they have given me is pretty easy at this point. It's just really hard for me to work with my preceptor when all he does is criticize me without giving me any type of constructive feedback..

Honestly... I feel like your preceptor is an extreme type A personality trying to force you to show confidence and a desire to succeed.

I think if you shake this victim mentality I think you've adopted for this rotation and fake confidence and drive to succeed.

 

[lord999]

What were specific examples of why you failed your students? Were they not able to do the work? Did they just not know certain knowledge?

Not discussing the behaviorals, that's just basic "Show up on time" kinds of problems.

Academic failures (by the way, the school is 80% women to 20% men now, while both of my failures were women, I estimate that out of the 80 or so students I have had from this school in my career, just 3 of them were male):

1. (She practices just fine now, I would willingly be her patient.) Could not deal with brand/generic conversions if their life depended on it (Lasix/furosemide). Made several major mistakes with drug flow calculations that three of them went down as incident reports (among other ones, had Amiodarone calculated for a 3g (not 300 mg) push and literally was getting the 20 vials when the supervising preceptor had stopped her). Week 3, had her take PARE for calculations and failed. Sent her back to the committee with a reference that she retakes pharmaceutical calculations as a requirement during her rearranged break rotation before being sent out again. She shaped up and did fine the second time. Just a failing competency matter that was rectifiable.

2. Frat member who was marginal pass (suspected then and proven later that she basically cheated her way through the program), never worked as a tech or an intern in school. First rotation. Fundamentally just did not know anything about medications. Week 2 of 6, sent her to take the full PARE and abysmally failed (as in the NAPLEX conversion score would have been in the 30s in the 2007 era). Sent her back with the committee recommendation that she retake her third year as the entire committee agree that she was not passable to the fourth year stage. Did not graduate.

In both cases, this was known at the first week's end, counseled with faculty witnesses by midterm, basically did all the paperwork necessary. That was the kindest thing I could have done. The worst thing I could have done was think that failing those two was not worth the paperwork bother (which I'm sure goes through many of our heads). It's not comfortable, but it's not abusive either. I truly suspect your preceptor is being abusive, but I only hear one side of the story. In cases where I think that is a suspicion in myself, that's why I have witnesses when I counsel or chew out trainees so that it cannot be said that I did so unprofessionally or in discrimination.