How many of you allow your first year pharmacy students counsel? If you don't normally allow them to counsel because they haven't worked in a pharmacy before would be willing to allow those interns who have work in pharmacy as a tech before (say like 4 years of exp) to counsel in their first year? Also, I expect that there is supervision in the counseling for those that allow it.
intern counseling
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It is really going to depend on the intern. If the intern has a background of tech experience and is pretty familiar with how a retail operation runs along with the pharmacist duties then some counseling seems like the most productive thing for the intern.
Start with the 10 most prescribed drugs and see how it goes. My preceptor is happy to let students get their feet wet right away if they want to and have the necessary skills.
It is really going to depend on the preceptor and the student's knowledge.
I totally agree. The pharmacist I work for however tells me he never lets first year students counsel, and I have requested not to intern with him because he is a dino stuck in his ways. He also has no respect for good techs or interns. He told me that if I was his intern he wouldn't even let me wear the white coat or my intern name badge. I told him thank god I requested not to work with you. He also said that just because you have the intern license doesn't give you the right to counsel. I told him perhaps not but legally it gives me the right too.
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generally, I would say no for first yr.....
I would like to see third yr or older.
really depends on teh person
I would like to see third yr or older.
really depends on teh person
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So I started counseling on drugs right when I was first an intern, before I even started school. Nothing difficult; I first did counseling on Vicodin. Obviously, the pharmacists helped me the first few times, and they did and continue to quiz me. The other interns where I work also started counseling soon after they started their jobs, although we all have slightly different knowledge levels based on year in school and what we've had the chance to learn.
It helps that we can counsel on certain drugs now. We can help out the pharmacists when they're busy doing stuff that legally only they can do. Besides, it helps your interns get better grades. I'm comfortable counseling, so I did better when I was graded on it at school!
Why would you wait until third year to start teaching someone to counsel? We started to learn how to counsel during our first year of classes, and if you don't practice, you'll never learn. Seems like a waste of an intern to me.
It helps that we can counsel on certain drugs now. We can help out the pharmacists when they're busy doing stuff that legally only they can do. Besides, it helps your interns get better grades. I'm comfortable counseling, so I did better when I was graded on it at school!
Why would you wait until third year to start teaching someone to counsel? We started to learn how to counsel during our first year of classes, and if you don't practice, you'll never learn. Seems like a waste of an intern to me.
Ya I told him it seems like a waste to not allow someone being paid as an intern not to perform intern duties. I am just hoping that the company I work for won't keep me there. I am worried however that because the store I work at has an intern that is graduating at the same time I become an intern. This could mean that they will just say well they need and intern and you're already there. I have asked numerous times and I don't want to sound like a trouble maker or someone who can't get along with others because I can. I just don't want to work some where that i will be hindered in my learning experience.
Well, for the people who can't make it past two years, this makes life for them much easier. Third year shows some drug knowledge, receptor activity, basic human A&P. At least in my school. If anything, you should be asking why schools don't start rotations earlier.
You should have a basic understanding of Human anatomy and physiology before you get into pharmacy school. Most schools also have two rotations after your first year of residency now. I actually think it is required if I remember correctly.
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I'm a bit confused as to what exactly you mean.
We're learning as we go, with A&P our first year, along with biochem for those who haven't had it before and a survey of the top 200 drugs and basic mechanisms of drugs. And when I counsel, I know the important points about the drugs. If the patient asks a question I can't answer, like alcohol with antibiotics, I ask the pharmacist.
While we don't start rotations before our fourth year, we do have to do a required volunteer internship in both outpatient and inpatient. That, along with internships, should give people some experience to choose what they want to do.
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definitely a NO NO...for first year regardless of previous experiences...
of course there's always exception, however, generally speaking NO NO.
On the other note, i've seen students at 3rd year and still don't know crap...when coming to counseling patients...yet worse, don't even know about drugs.
of course there's always exception, however, generally speaking NO NO.
On the other note, i've seen students at 3rd year and still don't know crap...when coming to counseling patients...yet worse, don't even know about drugs.
Why always a No? Is it because you don't trust your intern? If not why have an intern. Whats wrong with them counseling with a pharmacist by their side to help with the more difficult questions? Perhaps those third year students who don't know crap, didn't get the proper training and counseling practice because their pharmacist didn't allow them to do anything. It may not be their fault, but of course not all the blame should fall on one person, the intern is still responsible for not asserting themselves and making it known that they want to practice counseling.
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Exactly how many brain cells, previous experience, etc. does it take to tell someone that Vicodin will likely make you tired and dizzy, can upset your stomach so take with food, and can cause constipation, so eat fiber and drink lots of water? I guess there's the complicated factor of the 4000 mg limit of acetaminophen a day, but you should be able to divide 4000/500 to get 8, and be able to tell people to not take other meds that contain Tylenol, provided you've gone through college math.
The more important thing to be learning is how to interact with people, what kind of questions they ask, etc. while you're under someone and not out on your own. I've seen a pharmacist in action who had never done any outpatient/community work before graduating, and she was very uncomfortable. Not that she didn't know plenty of information, and I know she's a great inpatient pharmacist, but that was an unsettling experience for her.
Legally, at least in my state, as interns, we can do almost anything a pharmacist can PROVIDED it's under a pharmacist's supervision. I wouldn't want to wait until my third year to start counseling, doing transfers, and taking orders over the phone. And I would never dream of doing these things without the pharmacist's okay. How else are you going to learn these things??
The more important thing to be learning is how to interact with people, what kind of questions they ask, etc. while you're under someone and not out on your own. I've seen a pharmacist in action who had never done any outpatient/community work before graduating, and she was very uncomfortable. Not that she didn't know plenty of information, and I know she's a great inpatient pharmacist, but that was an unsettling experience for her.
Legally, at least in my state, as interns, we can do almost anything a pharmacist can PROVIDED it's under a pharmacist's supervision. I wouldn't want to wait until my third year to start counseling, doing transfers, and taking orders over the phone. And I would never dream of doing these things without the pharmacist's okay. How else are you going to learn these things??
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in general, yes....
but you have to look at their ability. I know 4th yr students I would not let fill my enemies' drugs.....
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Some states don't even legally allow it. New York doesn't issue intern permits until after the school has certified successful completion of P1 year. I think this is a good thing...even a tech with extensive work experience doesn't become qualified to speak with people about their medications just because they were accepted to a school.
A few suggestions have been to let them counsel on the more common drugs, or the "easy" drugs to cover. I agree that counseling a person on amoxicillin doesn't require any stupendous amount of brain power, but what happens when they ask a question about their mother's Gleevec or their son's Accutane? Interns are supposed to be well-supervised, but we all know that isn't always the case. I think it's better to avoid the issue altogether and wait until the student is far enough along to know what they don't know.
I realize that some states don't allow it. However, I live in a state that does allow students to get their intern license during their first year. To answer your question what about their mother's Gleevac or son's Accutane, they should get the pharmacist and listen to how they explain the medication. After that they should use one of the many handy software programs out there to do further research on the drugs so they can be more informed and better equiped to answer questions on them. It's a matter of responsiblity on both the pharmacist and the Intern. The pharmacist should not be allowing the intern to counsel on meds he doesnt know. But at the same time both the intern and the pharmacist should be working on improving the knowledge of the intern to make them a better pharmacist.
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To all of the P1 students who feel that it's an indignity that you can't do what you feel entitled to do: It's not your license on the line, that's why you don't get to make the call.
I am a P1, and my pharmacist does let me counsel on some things. And I feel perfectly capable doing them. However, I'll be the first person to tell you that I don't think a P1 student should legally be an intern, because we don't really learn jack about the drugs in our first year. Regardless of your experience level as a technician, there's a lot of difference between tech knowledge and pharmacy knowledge. Your allowance to counsel should depend on 1) How well your pharmacist thinks you can do and 2) How safely they think they can supervise. Your confidence in your abilities should only make the difference between you turning down the opportunity to counsel, it shouldn't get to override the pharmacist. If you'll notice, all of the "of course" statements in this thread are by students, and most of the "ehhhh...maybe..." are by pharmacists, who were students at one point and remember how little they knew.
I am a P1, and my pharmacist does let me counsel on some things. And I feel perfectly capable doing them. However, I'll be the first person to tell you that I don't think a P1 student should legally be an intern, because we don't really learn jack about the drugs in our first year. Regardless of your experience level as a technician, there's a lot of difference between tech knowledge and pharmacy knowledge. Your allowance to counsel should depend on 1) How well your pharmacist thinks you can do and 2) How safely they think they can supervise. Your confidence in your abilities should only make the difference between you turning down the opportunity to counsel, it shouldn't get to override the pharmacist. If you'll notice, all of the "of course" statements in this thread are by students, and most of the "ehhhh...maybe..." are by pharmacists, who were students at one point and remember how little they knew.
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If someone does ask a question about another medication that I have not been taught by either a pharmacist or how to counsel on it in school, I go get the pharmacist. Even if it's a medicine I've taken, and even if I know the molecular mechanism of how it works.
I answer the questions I can, I double-check with the pharmacist often, and I usually let the pt know I'm an intern, and if they have further questions, I'd be happy to get the pharmacist.
I thought it was a bit strange at first that being accepted to a school, I could legally do almost everything a pharmacist could. But that only pertains when I'm under a pharmacist's supervision. I got hired, I presume, in part because I was willing to take things slow and also defer to the pharmacists at all times. Heck, I even defer to the techs about the things they know better than I do!
The benefit of all this training I can see in the fourth years that are interns at my work. They appear to be ready to be pharmacists and know a lot. They've been counseling for almost four years, slowly adding to their knowledge base, and they seem to have the confidence to deal with issues when they finally are responsible for their own license.
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For some reason, I find it much easier to counsel patients at CVS than counsel my professors during pharmacy simulation. I especially hate the fact that I'm being video-taped while counseling in those labs.
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So you counsel, but you don't think you should? You feel capable but also that you don't think you should be an intern? That's odd. Maybe you should bring these things up with the pharmacist(s) you work with.
Maybe I feel a little differently because I have extensive molecular biology experience, although I don't think that not having that knowledge has hurt the other interns I work with. I have a PhD from doing diabetes research, where I learned easily that I might know a lot about diabetes, but that that doesn't mean I know a lot about everything. I laugh at the scientists in TV shows that know everything not only about biology but physics and computers, too. And even though I know the molecular mechanisms of simvastatin, rosiglitazone, and metformin, I know I know absolutely nothing about how to counsel on them!
Might you feel a little better if the drugs you counsel on, you not only know the key counseling points but also at least an idea of how the drug works? Not in great detail, but enough that you'd be able to tell a pt if they asked?
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I think you misinterpreted what I'm saying. I feel 100% confident on everything that I counsel. Everything I counsel on, however, mostly pertains to your basic cough/cold stuff and a few minor tidbits I know about drugs. And it's all information that I learned on my own through four or five years of tech work, not things that I learned during pharmacy school. Because, unless my school is drastically different than any other school, you don't learn any actual relevant information our first year aside from a few brand/generics that people cram and then forget fifteen minutes later. I made that clear to my PIC, and he understood, and told me that he listens to everything that I say, and as long as I'm right, he doesn't have a problem where the knowledge came from. And I'm the first to back off if something arises that I don't know the answer to.
The point that I was trying to make is that being an intern does not give you the right to counsel. We've had exercises in class where I was told by "experienced" interns that Celebrex was for acid reflux and any minor skin rash consult should be told to go directly to the doctor. From a pretty extensive selection of my class, I'd feel confident on maybe 10 of about 100 people dealing with even the most basic of situations, and even though I include myself in those 10, I'd happily not do it if the pharmacist didn't feel I had enough information at my disposal. It would ultimately be smarter and safer for the masses of pharmacy students if they couldn't become interns until their second year, because they might actually have some sort of information by that point, but it's given to first years because of the small minority.
In a nutshell: I'm capable enough of counseling on what I counsel on. The average first year tries to overstep their boundaries and often gives misinformation. While I'm quite happy with my abilities, I feel for the general safety of the pharmacy it'd be better for first years to not be able to counsel, but as long as they can, I'll do what i feel comfortable to.
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I live in the state of NY and what Pranzi said is true; we're not interns until we finish the first year of professional, or third year (which I am currently in).
What I meant to say was, that in your A&P classes and such there is nothing drug-related, specific taught. Sure, you might learn the mechanism of acetaminophen toxicity and what vitamin does what, but you do exactly what you say you do, ask the pharmacist. Everyone does.
During rotations you're doing this as well. My point was that interns have to wait until third year, and some people don't like that, but what the schools really should be doing is moving rotations to earlier years to expose the students to more medicine related experiences. Our school just started giving rotations third year, this semester, and it has been beyond eye opening working in a hospital and learning from clinical pharmacists. I'd've paid an extra 10k to do this in second year.
I'm not very good at getting points and ideas across, if you haven't noticed.
This is why when I councel, I make it a point to stay either next to, or within earshot of my pharmacist. That way if I am unsure, I can say "hold on a second" or "you can speak to my pharmacist in one second". But Celebrex acid reflux thing is funny!
I recently looked up the mechanism for Victoza and when I saw it was a Glucagon-Like Peptide Receptor Agonist that stimulated Insulin release, I did a double take. It's awesome knowing mechanisms.
I will be honest though, simvastatin confused me. Melavonic acid, Mevolinic acid look so similar!
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Regardless of your experience level as a technician, there's a lot of difference between tech knowledge and pharmacy knowledge. Your allowance to counsel should depend on 1) How well your pharmacist thinks you can do and 2) How safely they think they can supervise.I also like this post as well.
