P4 Rotation Stress. Help!

[Pharmguy92]

Hi,

I'm a P4 student and I'm currently on my very first rotation. It is an elective NICU/pediatrics. Today is my second day at the site and I feel so stressed out. I feel like I don't know what I'm doing. Classroom work and clinical work are so different. I have a hard time working up the patient. There are so many abbreviation and terms that I'm unfamiliar with. On top of that, my preceptor like to ask questions. I felt stupid when I couldn't answer the question (It is about 80% of the time). The thought of failing the rotation just keep running in my mind and it makes me want to burst out crying. This should not be normal for a first few days of rotation, is it? I'm close to the end and I want to succeed. Is there anything I could do to lower my stress level? Thank you for reading this.

UPDATE:

Hey guys,

Going through the threads and saw my old post, so I thought of doing an update. I recently graduated from pharmacy school and aced all of my 4th year rotations. Looking back now I think I was really overstressed and worry about things that I should not have. I was always worried about not knowing the information when preceptor is asking a question or was not good enough of a student. And the truth is I will never be good enough or I will not always know the information right there and then. The 4th year to me is all about learning new information fast and be able to look up answers quickly and get back to your preceptor (However, you do need to know your basic). So for anyone starting 4th year and is stressing out too much, don't be. You will always feel like you don't know what you're doing couple of weeks in, but you will get the hang of it, and that's what your preceptor is looking for, improvement. I also want to thank the forum for all the advice here, it really did help.

Now it's time for me to stress out about my NAPLEX lol.

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[owlegrad]

Hi,

I'm a P4 student and I'm currently on my very first rotation. It is an elective NICU/pediatrics. Today is my second day at the site and I feel so stressed out. I feel like I don't know what I'm doing. Classroom work and clinical work are so different. I have a hard time working up the patient. There are so many abbreviation and terms that I'm unfamiliar with. On top of that, my preceptor like to ask questions. I felt stupid when I couldn't answer the question (It is about 80% of the time). The thought of failing the rotation just keep running in my mind and it makes me want to burst out crying. This should not be normal for a first few days of rotation, is it? I'm close to the end and I want to succeed. Is there anything I could do to lower my stress level? Thank you for reading this.

I can't speak for your preceptor but most of the time when I ask a question, I do not expect my student to know the answer. How boring would it be to ask questions where the student already knows the answer? I imagine they are probably just probing your knowledge base and trying to expand it. When you don't know the answer just admit you don't know and offer to look it up and get back to them.

Or even better...

Often what I really want when I ask a question is a discussion about the topic, not an exact answer to the question and I expect that is pretty common across the board so rather than coming at if from a perspective of "I don't know, can you give me three wrong choices and one right one" think of it and respond more like "well I know this and I think this but if you want a more specific answer I need time to review". I suspect your preceptor will appreciate that. Sometimes they might want you to actually do the research but sometimes they will just give you the answer and move on - often they will just want to review the topic and have a discussion I suspect (at least that is my case).

 

[Ninetails]

Hi,

I'm a P4 student and I'm currently on my very first rotation. It is an elective NICU/pediatrics. Today is my second day at the site and I feel so stressed out. I feel like I don't know what I'm doing. Classroom work and clinical work are so different. I have a hard time working up the patient. There are so many abbreviation and terms that I'm unfamiliar with. On top of that, my preceptor like to ask questions. I felt stupid when I couldn't answer the question (It is about 80% of the time). The thought of failing the rotation just keep running in my mind and it makes me want to burst out crying. This should not be normal for a first few days of rotation, is it? I'm close to the end and I want to succeed. Is there anything I could do to lower my stress level? Thank you for reading this.

Well, talk to your preceptor first. Go ahead and tell them you don't know the abbreviations and ask them if they have any recommendations for reading materials that could quickly bring you up to speed on them because you want to be able to have an intelligent discussion. Ask what are the main conditions they see and review them at night so that you can understand better. If they are asking you dosing, unless it is basic (Tylenol or ibuprofen) they probably don't expect you to know it on the spot. I worked in peds for a time and I can say it took about 2 months to become completely fluent in the dosing regimen of the formulary (and I still needed to look up renal peds dosing for random drugs from time to time in those random special needs patients). I knew quite a bit just from checking doses as a regular staff pharmacist but unless it is all you do every day, the doses aren't going to lodge into your brain on their own.

Try to absorb in this rotation. Not many people are able to appreciate the immense responsibility and difficulty in caring for pediatrics. Remember you cannot treat premature the same as neonates or infants or children or adolescents. These groups are extremely different physiologically with different barriers to overcome but under one field of specialty.

Best of luck!

 

[Chriskahn]

Thats crazy that your first rotation is NICU/peds. My school didnt allow anyone to do any type of ICU, ED, or specialty rotation without first completing an inpatient hospital rotation (probably to avoid situations like yours)

With that said, you wont fail unless you did not meet your preceptor's expectation after the midpoint eval. So dont worry so much about the first half of the rotation. Just focus on learning as much as you can and review what you learned that day when you get home. Always get plenty of rest. You dont want to be tired during the day trust me. Try to read up and study on the weekends also.

Give it some time. A couple weeks in and you will definitely get the hang of it and will know way more than you did when you first started

 

[positivesign]

Just to encourage you, I want to mention that it is "normal" to feel that you don't know anything in this rotation.
Pediatrics is a specialty field even for pharmacists. Just because you learned certain things in your clinical module during pharm school doesn't mean that you are prepared to practice in this field. Everybody has to start somewhere and for you, this rotation is the start.
I remember the pressure to answer the preceptor's questions. When I was a P4, I felt miserable when I didn't know the answer esp. in the field I was most interested in. Now as a pharmacist, looking back, I think I stressed out a bit too much.
Here's the perspective, bring your A-game, but don't force yourself into believing that you need to know as much as your preceptor--that isn't possible right? Take your preceptor's questions as a guide to familiarize yourself in this setting. It will usually be the recurring topics that's bread and butter for NICU pharmacists, or something fancy/rare that you were lucky to see. If you don't get it on the first go, research the topic and get back to the preceptor. That's how they know about your learning progress.
When you work up a patient, be as detailed as possible and don't be discouraged when the preceptor starts critiquing. They'll let you know what you missed so you can improve. They're trying to help you so that you can build your own effective process.

Don't forget to ask for a mid-rotation evaluation. That's often the time for preceptors to bring out where students need to improve. Sometimes, it is skipped/forgotten and students have no idea what they are lacking/missing out until the end. That's not fair.

 

[Rouelle]

You said everything applicable in your post: 2nd day, first rotation, medicine rotation, NICU setting. It would be much more concerning if you thought you weren’t lost.

I had a NICU rotation. Classes don’t prepare you for that. Look stuff up, ask why, listen a lot. Keep a copy of Pediatric and Neonatal Dosage Handbook (Lexi) handy. You’ll get there.

 

[johnpharm01]

I know what I would do. I would study what a NICU is, whats it stand for, why are these babies here and not at home keeping their parents up by crying (medical conditions) and how these medical conditions are treated (especially drugs), how long they stay, etc. I would research lay material first then get into some basic medical oriented material. This would give me a frame of reference and the "big picture." I would also review my pediatric notes from class and dipiro. Then I would ask my preceptor for good material to study from and also carry a notebook to jot down terms, diseases, doses I hear frequently and look them up.

 

[johnpharm01]

I'll expound. I did a psych pharm residency. Rounded on inpatient psych unit (double locked). Why were folks here? Mostly acutely ill psychiatric patients but some faking illness to avoid judicial system. What psychiatric illnesses? Lots of bipolar disorder and schizophrenia, sometimes MDD, GAD, dementia and alcoholics. They would stay only as long as it took them to get stabilized. How did they end up here? Some bizarre behavior often the police dropping them off sometimes their family. Why were they there? Lots of time because they stopped taking there meds because they felt better, sometimes newly diagnosed patients. Lots of frequent readmissions. They also had medical problems. That would get the background then you could get into the specifics of which drug maybe better for them, if they were having side effects. What new regimen may help them. Maybe a referral to the psychologist.

 

[Lexington2012]

I had a rotation like yours. It really helped when I talked to a student who had been through it the prior year. He told me to just work hard and know that after 5 weeks the entire rest of my life will be easier. He was right. All my other rotations were much less challenging.

 

[Cleaveland]

Review, review and more review. When you get home study topics from your school notes and read guidelines like it's your bible. Stay motivated, and keep close with your preceptor. If you don't know the answer to a question, write it down and let the person know you'll get back to them asap. Also if you have a rotation that seems a little difficult the following block, try to review on the weekends and prepare as much as possible. I did this and did really well on my rotations!

 

[Pharmguy92]

Thank y'all for all the feedbacks. Y'all really help to calm me down. Today is my last day of the first week and my stress level has reduced significantly. My preceptor saw me getting super nervous the other day when she asked questions so she calm me down and said "Be calm. I don't expect you to know all the answer during your first week. But if I ask you that question again in the future, you better know it." So that was nice of her. I'm more comfortable working up patient and I see NICU in a different light now. With that said, it's still very challenging but I will try to learn all that I could and make an A out of this rotation.