Not impressed with pharm residencies.....

[MacGyver]

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Let the hate mail commence, but I gotta call it like I see it....

I'm a med student at a large program with a very good pharm school, one of the best in the country.

We round with patients with 2 pharmacists, an attending and a "resident."

Our typical census carries 30 patients or so.

My experience is that out of 30 patients, the pharmacists might suggest a change in medication maybe once a week or so. And when the make a suggestion, its very much a "gray" area that could go either way and is subject mostly to prescriber preference.

I've NEVER seen a pharmacist suggest a medication change in which the team said "oh my god you are so right, I cant believe we missed that or overlooked it"

The vast majority of the time, the pharmacists dont play any role in patient care. They just take notes on all the patient meds and dont contribute anything. That could be because they are shy and dont want to speak up, but my instincts tell me its because when medicine interns are working up patients they have already considered 99.5% of all the pharm issues and have worked it up appropriately.

Maybe the pharm residencies at my school suck compared to the others, but this is what I see on a day to day basis.

 

[Trancelucent1]

What exactly would you like us to do? It all depends on the program. It's unfortunate that that is how you see it, but other factors might be involved. I've seen pharmacy students on rotations that I thought weren't very knowledgeable. I've also seen some Dr's that I thought were idiots (some of the scripts I've seen are just bad calls). I've also been very impressed with some pharmacists and doctors. I've got a friend who's a med student who always tells me how helpful the pharmacists are and how impressed he was. There are a lot of factors involved. I don't really know what you're trying to get with this post. It doesn't seem like anything really constructive is going to come out of the post.

 

[twester]

Thanks for sharing. Your career hasn't even started yet and you're ready to discount all pharmacists? Interesting... 🙂

 

[SobeGekko]

As a former medical resident, I have to respectfully disagree with your assertions about pharmacists. At my residency, there are pharm students that round with the medicine teams and they are constantly teaching the medical residents nuances of drugs (delivery, dosing, distribution, formulation, side effect profiles) that the young docs don't know about, have never been, taught, and haven't ever thought about. They don't always change prescribing practices, but often do and certainly make the docs more informed on what they're prescribing.

They also can just about daily answer a drug question that stumps all the med students, residents, and attendings. I think that when pharm students, residents, or staff pharmacists are not involved in medical rounds, many pharmacological questions not only go unanswered but also unasked because med students are generally trained only to know the right drug to give. Typical physicians (because most of the time it is superfluous to their job) do not know much about pharmacokinetics, pharmacodynamics, etc that are very important to the success use of medications. This is where pharmacists of the future will add expertise and significant value to the way medicine is practiced.

 

[konkan]

Let the hate mail commence, but I gotta call it like I see it....

I'm a med student at a large program with a very good pharm school, one of the best in the country.

We round with patients with 2 pharmacists, an attending and a "resident."

Our typical census carries 30 patients or so.

My experience is that out of 30 patients, the pharmacists might suggest a change in medication maybe once a week or so. And when the make a suggestion, its very much a "gray" area that could go either way and is subject mostly to prescriber preference.

I've NEVER seen a pharmacist suggest a medication change in which the team said "oh my god you are so right, I cant believe we missed that or overlooked it"

The vast majority of the time, the pharmacists dont play any role in patient care. They just take notes on all the patient meds and dont contribute anything. That could be because they are shy and dont want to speak up, but my instincts tell me its because when medicine interns are working up patients they have already considered 99.5% of all the pharm issues and have worked it up appropriately.

Maybe the pharm residencies at my school suck compared to the others, but this is what I see on a day to day basis.

Didn't you mention on pharmacy forum, maybe a year ago or so, that you have your own practice and that you can get whatever medication you need online for your patients? What happened? They took away your license and put again into med. school to repeat stuff?

 

[sdn1977]

MacGyver!

You're back....welcome! Did some other forum kick you off?

Welcome back.....and thanks for the input. We'll be sure to let you know if we see anything amiss.

It appears you are doing EVERYTHING perfectly pharmaceutically-wise.

😀

 

[pharmboy30]

As a former medical resident, I have to respectfully disagree with your assertions about pharmacists. At my residency, there are pharm students that round with the medicine teams and they are constantly teaching the medical residents nuances of drugs (delivery, dosing, distribution, formulation, side effect profiles) that the young docs don't know about, have never been, taught, and haven't ever thought about. They don't always change prescribing practices, but often do and certainly make the docs more informed on what they're prescribing.

They also can just about daily answer a drug question that stumps all the med students, residents, and attendings. I think that when pharm students, residents, or staff pharmacists are not involved in medical rounds, many pharmacological questions not only go unanswered but also unasked because med students are generally trained only to know the right drug to give. Typical physicians (because most of the time it is superfluous to their job) do not know much about pharmacokinetics, pharmacodynamics, etc that are very important to the success use of medications. This is where pharmacists of the future will add expertise and significant value to the way medicine is practiced.

I agree. Drug my acute care rotation, we rounded with the medical team. We were all assigned a resident and followed their patients. I made at least 5 recommendations a day. Did drug information research for them, monitored patients renal functions and made recommendations about dosing changes, followed relevant changes in labs, read attending notes on patient progress and recommended accordingly. We also made recommendations on alternative/cheaper meds that the patient could be discharged with.

Also depends on the attending, some are more open to recommendations than others.

 

[pharmtastic]

I've NEVER seen a pharmacist suggest a medication change in which the team said "oh my god you are so right, I cant believe we missed that or overlooked it"

Why are you disappointed? Arent you supposed to feel very happy when this happen??? Why??? This indicates that the physicians at your hospital prescribe very appropriate medications. The pharmacist understand "If it's not broken, dont fix it".

Now, if there are 30 patients on round, and the pharmacist have to suggest medication change (clear change, not "gray") for 10 patients or so, then IT IS TIME TO WORRY about the ability of the prescribers at your hospital.

 

[spacecowgirl]

Didn't you mention on pharmacy forum, maybe a year ago or so, that you have your own practice and that you can get whatever medication you need online for your patients? What happened?

No, I think that's FamilyMD 😍 While they both know everything about everything, MacGyver can narrowly escape from a car trunk in the bottom of a river with nothing but pantyhose, a bungie cord and a popsicle stick.

We bow to you, wise one.

 

[ProZackMI]

I hate to respond negatively, but...what a *****! During my IM/Psych residency at the University of Michigan, I found the PharmDs and residents to be invaluable. Especially the psychopharm clinical pharmc (BCPPs) who knew more than psychiatry preceptors. I think having clinical pharmacists and pharm residents on rounds was one of the best things to come along in postgraduate medical education.

My experiences have been nothing but positive. If I have any questions on a particular drug, I can either PDR it or consult with a few pharms who know psychotropics inside and out.

👎 No way, MacGyver. Your anectodal evidence is not persuasive, nor is it dispositive. There are duds in every field, medicine included. I wonder how you are on rounds? Is your input valued by your colleagues, or do they see you an "underachiever"?

It's all a matter of perspective, ego, and experience I suppose.