Residency Applicant Support Thread

[cycloketocaine]

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im surprised they asked a pedes question (unless it is a pedes residency)

It was a freestanding children's hospital.....I'm a peds person all the way.

 

[cycloketocaine]

First interview this morning!

Good luck! Let us know how it goes!

 

[All4MyDaughter]

Good luck! Let us know how it goes!

Thanks!

I think it went well! It's a residency that is a joint effort between my COP and a local hospital. I met with the staff at the hospital this morning and then with the COP-based preceptors in the afternoon.

I also got two more interview invitations today so my current status is:

Applied to 5 programs:
1 "we got your stuff" email
1 interview completed
1 interview scheduled
2 pending interviews not yet scheduled

 

[lorain]

Thanks!

I think it went well! It's a residency that is a joint effort between my COP and a local hospital. I met with the staff at the hospital this morning and then with the COP-based preceptors in the afternoon.

I also got two more interview invitations today so my current status is:

1 "we got your stuff" email
1 interview completed
1 interview scheduled
2 pending interviews not yet scheduled

what kind of questions did they ask?

 

[All4MyDaughter]

what kind of questions did they ask?

Lots of behaviorial questions like:

• Tell me about a time you decided to do something and people were discouraging. How did you handle it?
• How do you handle angry/irate/abusive patients/clients/prescribers/nurses?
• Describe a time when you were given a task but didn't have the resources or skills to do it. What did you do?

The usual "Why would you be a good resident?" and "Why would you not be a good resident?" kind of things.

Then there were site specific questions which I believe were designed to "weed out" those people who are just applying for every residency under the sun, hoping to get SOMETHING. Stuff like, "What could bring to the table to enhance our existing programs or help us grow?" and "What do you like about this site?"

 

[lorain]

Lots of behaviorial questions like:

• Tell me about a time you decided to do something and people were discouraging. How did you handle it?
• How do you handle angry/irate/abusive patients/clients/prescribers/nurses?
• Describe a time when you were given a task but didn't have the resources or skills to do it. What did you do?

The usual "Why would you be a good resident?" and "Why would you not be a good resident?" kind of things.

Then there were site specific questions which I believe were designed to "weed out" those people who are just applying for every residency under the sun, hoping to get SOMETHING. Stuff like, "What could bring to the table to enhance our existing programs or help us grow?" and "What do you like about this site?"

how did you answer the 'bring to table' question?

 

[cycloketocaine]

how did you answer the 'bring to table' question?

Lol. I'm sure she said what she felt she could bring to the program.

 

[lorain]

i was just asking in general

like bring up relevant experience, knowledge?, or more values such as hard working, putting in extra effort, etc.

 

[All4MyDaughter]

how did you answer the 'bring to table' question?

Lol. I'm sure she said what she felt she could bring to the program.

Management experience from my previous career. Program development and assessment skills. Desire to precept students and implement forms of structured learning for rotating students (Journal Clubs, topic discussions, presentations). Interest in researching the feasibility and need for a PGY2 residency at the facility. Hotness. The usual stuff, I guess. 😉

 

[cycloketocaine]

i was just asking in general

like bring up relevant experience, knowledge?, or more values such as hard working, putting in extra effort, etc.

I used examples of both, and emphasized te previous experience more.

 

[lorain]

my first onsite interview is coming up

1) take extra copy of CV
2) presentation paper they requested
3) updated transcript

anything else I should take?

 

[All4MyDaughter]

my first onsite interview is coming up

1) take extra copy of CV
2) presentation paper they requested
3) updated transcript

anything else I should take?

I made two extra copies of CV and used them both. I also had my rotation portfolio and referred to it as appropriate. I didn't take any transcripts b/c mine were just issued last month and are current as far as I know.

 

[lorain]

I made two extra copies of CV and used them both. I also had my rotation portfolio and referred to it as appropriate. I didn't take any transcripts b/c mine were just issued last month and are current as far as I know.

thanks!

Im nervous as this is the place I want to be and want to make a good impression

 

[Farmercyst]

They'll probably ask about some oncology related stuff...do they have BMT unit? If so, I would read the latest Neutropenia guidelines...just published like 2 weeks ago.. of cystic fibrosis?

Maybe something on short gut syndrome and need for enteral feed..

LOL... j/k.

27 YO M febrile, White count 15K, consolidations on xray, suspected CAP, what would you do?

I did a ppt presentation on NEC at one of my rotations and was asked about that. Also asked about early vs late sepsis (completely bombed).

Pt has an aptt of 120 what would you do? Monitoring parameters?

Prioritize
1.) Pt has a vanco trough of 30
2.) Pyxis out of IV Ativan
3.) ICU needs DA gtt
4.) MD has question about new off-label use for reglan in peds pt.

I asked when last dose was given, timing of trough in relation to previous dose and timing of next dose. When next dose of ativan was scheduled, and when MD needed info by. I figured that would give me enough info to answer appropriately without just assuming everything was given at face value.

 

[Farmercyst]

I made two extra copies of CV and used them both. I also had my rotation portfolio and referred to it as appropriate. I didn't take any transcripts b/c mine were just issued last month and are current as far as I know.

What did you use the copies of your CV for? I just figured they'd give a copy to any one who needed it.

 

[cycloketocaine]

27 YO M febrile, White count 15K, consolidations on xray, suspected CAP, what would you do?

I did a ppt presentation on NEC at one of my rotations and was asked about that. Also asked about early vs late sepsis (completely bombed).

Pt has an aptt of 120 what would you do? Monitoring parameters?

Prioritize
1.) Pt has a vanco trough of 30
2.) Pyxis out of IV Ativan
3.) ICU needs DA gtt
4.) MD has question about new off-label use for reglan in peds pt.

I asked when last dose was given, timing of trough in relation to previous dose and timing of next dose. When next dose of ativan was scheduled, and when MD needed info by. I figured that would give me enough info to answer appropriately without just assuming everything was given at face value.

Holy geez. I get the pna and the prioritzation but the others are just being mean! Where was this?

 

[Its Z]

Holy geez. I get the pna and the prioritzation but the others are just being mean! Where was this?

LOL, welcome to CA... that's not mean...that's how it should be.

They mixed in clinical, DI, and operations rolled all into one! I love it. Props to Long Beach!

Years ago... when I was a student, Long Beach Memorial was considered one of the clinical pharmacy meccas... many clip board pharmacists rounding etc. They soon realized that model wasn't cost effective and done away with it. Good move.

That area swarms with USC, UCSF, and UOP grads...

 

[cycloketocaine]

You welcome. I suggest you read IDSA CAP Guidelines and also read up on CMS/TJC Pneumonia Core Measures...

In fact, you may also want to brush up on CHF, AMI, VTE, & Stroke Clinical Quality Outcome measures...

If you can't download the IDSA CAP Guidelines, send me a pm...I'll send it to you.

I'm so bored I am actually reading these for my interview next week. Gah.

 

[Its Z]

Pt has an aptt of 120 what would you do? Monitoring parameters?

I love this question. And if you havne't worked inpatient, I just don't know how you'd answer correctly.

You have to take into consideration of what the hospital IV Heparin Infusion protocol entails. Because aPTT from one institution to next will vary according to the reagent they use.

My response would have been:

1. What is the patient being treated for, MI, PE, DVT, or AF?
2. Has the patient previoulsy received any thrombolytics or IIBIIIA
3. Can I see the IV Heparin Protocol and the sliding scale? Because that's where it will state how to taper or increase the drip rate...
4. Do you run an annual anti-factor X vs. Heparin conc (aptt) nomogram to ensure therapeutic range falls 0.3 - 0.7?

And go from there!

All this information is in the latest CHEST Guidelines... I would suggest you read it..if you haven't!

 

[Its Z]

I'm so bored I am actually reading these for my interview next week. Gah.

You need the CHEST guidelines? I don't think you can get it free... if you need it, let me know..I can zip them..there are like 25 articles... or go out and buy you a copy.

 

[Its Z]

Prioritize
1.) Pt has a vanco trough of 30
2.) Pyxis out of IV Ativan
3.) ICU needs DA gtt
4.) MD has question about new off-label use for reglan in peds pt.

1. ICU drip first while telling the tech to go fill IV Ativan.. (someone could be in DTremens or need IV ativan for sedation - vent patient etc...or patient could be in status.)

2. Answer MD question.

3. Deal with Vanco last... quite frankly, what harm will Vanco trough of 30 do? intermittent renal toxicity that's reversible? I would then segway into "USC study at Huntington Memorial recenly saw that vanco renal toxicity is reversible even though it's more prevalent in trough over 20, it's not as serious as we have thought. Also, non-reversible ototoxicy, as rare as it is, it would really need vanco level of about 70ug/ml..


Well, 2 and 3 are interchangeable... well, maybe Vanco first then MD question.

 

[lorain]

27 YO M febrile, White count 15K, consolidations on xray, suspected CAP, what would you do?

I did a ppt presentation on NEC at one of my rotations and was asked about that. Also asked about early vs late sepsis (completely bombed).

Pt has an aptt of 120 what would you do? Monitoring parameters?

Prioritize
1.) Pt has a vanco trough of 30
2.) Pyxis out of IV Ativan
3.) ICU needs DA gtt
4.) MD has question about new off-label use for reglan in peds pt.

I asked when last dose was given, timing of trough in relation to previous dose and timing of next dose. When next dose of ativan was scheduled, and when MD needed info by. I figured that would give me enough info to answer appropriately without just assuming everything was given at face value.

ROFL i wouldve failed that one 👎

 

[rxlea]

Haha having worked inpatient for a while, I could have probably decently answered that question.

Although, I would have probably just had the tech pull a dose of ativan out of the CII safe and deliver it to the nurse immediately after taking care of the ICU drip. Then have them fill the pyxis. Tube station works good in this instance, too.

If needed, (if there was only 1 tech), I would have them pull the ativan while I make the drip.

 

[owlegrad]

Haha having worked inpatient for a while, I could have probably decently answered that question.

Although, I would have probably just had the tech pull a dose of ativan out of the CII safe and deliver it to the nurse immediately after taking care of the ICU drip. Then have them fill the pyxis. Tube station works good in this instance, too.

I agree, unless there is a trick I don't see that seemed pretty easy.

ICU>Atavan>MD=Vanco

Your techs can get into the CII safe? And what nurse would she deliver it to? The question just says Pyxis is out, doesn't say who needs it, or if it is needed at all (right now).

 

[rxlea]

I agree, unless there is a trick I don't see that seemed pretty easy.

ICU>Atavan>MD=Vanco

Your techs can get into the CII safe? And what nurse would she deliver it to? The question just says Pyxis is out, doesn't say who needs it, or if it is needed at all (right now).

Well, nurses don't usually call when pyxis is out unless they tried to pull something out and they couldn't. So, I would have the check to see if it is indeed out (could be other problem as well). If it is OUT, it takes longer to pull out say 10 ativan run it up there, fill it, then let the nurse in to pull out her dose than it does for a tech to pull one out, have me check it, and send it secured tube or have the tech run it up to the nurse in charge of that patient. Make sense? The drip can be tubed as soon as it is made/checked. It would take just a minute to do that. Tube it, sign off on ativan so tech can deliver, take MD call. Deal with vanco after.

 

[All4MyDaughter]

We make all our Ativan drips in glass bottles. Can you tube a glass bottle? We don't have a tube system, but just curious.

 

[cycloketocaine]

We make all our Ativan drips in glass bottles. Can you tube a glass bottle? We don't have a tube system, but just curious.

We can, but you better pack it tighhhhtttt.....however, we do not tube controls.

 

[rxlea]

Its not a drip if it is in Pyxis. It's the vial. Also, the drip goes in a non-PVC bag, not bottle so yes, it can be tubed. We have a "secure" tube method where we call the nurse give her a code and she waits for it on the other end. But that's only for controls. Fastest way to get it to her is tube or directly in hand. When we tube stuff to ICU that's not controlled, it rings the bell and they know it's there.

 

[All4MyDaughter]

What did you use the copies of your CV for? I just figured they'd give a copy to any one who needed it.

When I had my formal, sit down interview in the morning they had my application materials in front of them. In the afternoon, I met individually with different preceptors who weren't in on the morning interview. They didn't have my CV so I gave them copies.

 

[lorain]

When I had my formal, sit down interview in the morning they had my application materials in front of them. In the afternoon, I met individually with different preceptors who weren't in on the morning interview. They didn't have my CV so I gave them copies.

just wondering, did the preceptors ask ?s or did they just explain what they do in their department? (or both)

 

[All4MyDaughter]

just wondering, did the preceptors ask ?s or did they just explain what they do in their department? (or both)

They asked about my career goals, what I was hoping to get out of residency, what led me to choose that particular residency, etc. It was more conversational than a formal interview, but they were interview-type questions. They also talked about their roles in the residency and what I'd be doing with them.

 

[lorain]

They asked about my career goals, what I was hoping to get out of residency, what led me to choose that particular residency, etc. It was more conversational than a formal interview, but they were interview-type questions. They also talked about their roles in the residency and what I'd be doing with them.

sweet thanks

i got a rejection email from a site...this is in a relatively small area, 250 apps for 2 spots....they claim they actually took the time to go thru it, but damn it is so competitive

 

[eeyore spice]

Are VA hospitals in high demand? I was thinking of starting a thread asking which programs are the most competitive...and I probably should have done that in November...

 

[lorain]

Are VA hospitals in high demand? I was thinking of starting a thread asking which programs are the most competitive...and I probably should have done that in November...

honestly, any decent program is competitive

i just read the letter the site sent me (didnt see it attached to the email b4), they said they have never received as many apps as this year b4

 

[owlegrad]

Well, nurses don't usually call when pyxis is out unless they tried to pull something out and they couldn't. So, I would have the check to see if it is indeed out (could be other problem as well). If it is OUT, it takes longer to pull out say 10 ativan run it up there, fill it, then let the nurse in to pull out her dose than it does for a tech to pull one out, have me check it, and send it secured tube or have the tech run it up to the nurse in charge of that patient. Make sense? The drip can be tubed as soon as it is made/checked. It would take just a minute to do that. Tube it, sign off on ativan so tech can deliver, take MD call. Deal with vanco after.

When our MedDispense Machines run out of something (i.e., when the last unit it taken out) a report is automatically printed out as soon as it happens alerting us to the outage, so nurses don't need to call us about it. Needing a nurse to call about Pyxis being out of something sounds like bad work flow, imo. How common is that setup I wonder? So much easier I would think to just have a report run instead of having a nurse call....

 

[owlegrad]

Well, nurses don't usually call when pyxis is out unless they tried to pull something out and they couldn't. So, I would have the check to see if it is indeed out (could be other problem as well). If it is OUT, it takes longer to pull out say 10 ativan run it up there, fill it, then let the nurse in to pull out her dose than it does for a tech to pull one out, have me check it, and send it secured tube or have the tech run it up to the nurse in charge of that patient. Make sense? The drip can be tubed as soon as it is made/checked. It would take just a minute to do that. Tube it, sign off on ativan so tech can deliver, take MD call. Deal with vanco after.

This reminds of something that happened once. The machine ran out some kind of inhaler, although the machine thought it had more it was really out. So nurse calls and I deliver inhaler to patients med cart within 5 minutes of the call. Fast-forward maybe 2 hours and the nurse calls me back and wants to know IF I AM EVER GOING TO FILL THE MACHINE! I tell her I delivered the inhaler directly to the patient's cart drawer so she would not have to go through the trouble of pulling it out of the machine. The humor may be lost in this post, but it made me .

 

[psychoandy]

I think most every VA is competitive (everyone sweats PGY1 with AmCare), as well as any US News and World Report hospital, especially in the desirable big cities with adjacent pharmacy schools...which happened to be everywhere I applied to 🙁

I'm also shocked at all the interviews already. I still have 4 crickets!

When our MedDispense Machines run out of something (i.e., when the last unit it taken out) a report is automatically printed out as soon as it happens alerting us to the outage, so nurses don't need to call us about it. Needing a nurse to call about Pyxis being out of something sounds like bad work flow, imo. How common is that setup I wonder? So much easier I would think to just have a report run instead of having a nurse call....

My hospital's system usually has 2 drawers for high volume items, such as morphine/dilaudid vials. When RNs call, 75% of the time there's another drawer they don't know about and they're being proactive/freaking out because the 1 drawer is empty. IMO it's worse with non-controlled items, because no one counts them daily and RNs will take out say 5 albuterol nebs instead of 1, lose all of them, and then get all angry when they run out.

 

[lorain]

^i think one just has to look at the application deadline, and add + 3weeks to it, if one has not heard back then its a denial....thats the pattern Im seeing with my apps

 

[owlegrad]

...
My hospital's system usually has 2 drawers for high volume items, such as morphine/dilaudid vials. When RNs call, 75% of the time there's another drawer they don't know about and they're being proactive/freaking out because the 1 drawer is empty. IMO it's worse with non-controlled items, because no one counts them daily and RNs will take out say 5 albuterol nebs instead of 1, lose all of them, and then get all angry when they run out.

Yes, that is annoying. The nurses suffer also (waiting for us to refill), it just doesn't make sense. Take out what you recorded that you took out, not "get the drawer to open and help yourself". Annoying. Then the other nurses go to get some and it is empty - did I mention annoying?

 

[psychoandy]

^i think one just has to look at the application deadline, and add + 3weeks to it, if one has not heard back then its a denial....thats the pattern Im seeing with my apps

don't make me cry...i'm still sticking to my theory that the local hospitals I applied to put mine on the backburner bc I'm local and out of area gets priority.

Yes, that is annoying. The nurses suffer also (waiting for us to refill), it just doesn't make sense. Take out what you recorded that you took out, not "get the drawer to open and help yourself". Annoying. Then the other nurses go to get some and it is empty - did I mention annoying?

what grinds my gears even more is insulin vials...1 person pockets the lantus/humalog/nph/R vial and suddenly the whole floor is out and everyone needs to eat. Meanwhile god forbid JCAHO finds a loose insulin vial with the exp date peeling off.

sometimes i wonder why i'm going residency, i think i'd be way better at logistical issues like this.

 

[rxlea]

When our MedDispense Machines run out of something (i.e., when the last unit it taken out) a report is automatically printed out as soon as it happens alerting us to the outage, so nurses don't need to call us about it. Needing a nurse to call about Pyxis being out of something sounds like bad work flow, imo. How common is that setup I wonder? So much easier I would think to just have a report run instead of having a nurse call....

We get print outs when things are out, too. But, we do two pyxis fills a day and we get print outs for "critical low" meaning the runner tech fills it before it runs out. If a NARC actually runs out (rare), it is because a patient is on a high dose and is going through it faster than normal. So, usually, if something is "out" and is an immediate need, it is because somebody called/faxed to say so and needs a dose now. We have excellent workflow where I work. Which, from that question, I would assume the nurse tried to get a dose of ativan and noticed it was out and contacted pharmacy.

 

[R2pharmD2]

what grinds my gears even more is insulin vials...1 person pockets the lantus/humalog/nph/R vial and suddenly the whole floor is out and everyone needs to eat. Meanwhile god forbid JCAHO finds a loose insulin vial with the exp date peeling off.

I think just about every time I refill novolin R the count is off.

 

[rxlea]

Also, we put blind counts on albuterol and ipratropium so the resp therapists don't throw our counts off. Also, everyday, the team lead + one nurse count the narcs.

 

[owlegrad]

We get print outs when things are out, too. But, we do two pyxis fills a day and we get print outs for "critical low" meaning the runner tech fills it before it runs out. If a NARC actually runs out (rare), it is because a patient is on a high dose and is going through it faster than normal. So, usually, if something is "out" and is an immediate need, it is because somebody called/faxed to say so and needs a dose now. We have excellent workflow where I work. Which, from that question, I would assume the nurse tried to get a dose of ativan and noticed it was out and contacted pharmacy.

That's a pretty big leap, but I get how you were answering the question now. When I read "Pyxis out" I assumed it meant just plain ole' out; you read it as Pyxis out and nurses are calling you, begging you, pleading with you to please, please fill it. 😉

Do y'all ever reset par after running out of something? My DOP lets me if I ask her, but for some reason it is not SOP to do so.

 

[owlegrad]

Also, we put blind counts on albuterol and ipratropium so the resp therapists don't throw our counts off. Also, everyday, the team lead + one nurse count the narcs.

What's that?

 

[rxlea]

What's that?

It forces the nurse/resp therapist to count what is in the drawer and enter it without telling her/him what the true count is so that if it is off, they will know when it happened (to find out who got the count all messed up). They do it for narcs, inhalation solutions and expensive meds (linezolid PO). In regards to your other question, clearly with a question like that you would want more info about the scenario. I would probably ask how many techs arte available and how we were contacted about the pyxis being out. Workflow varies from place to place, but if ativan is out where I work, that's just weird/unusual and either the count is off or someone was lazy and didn't do their job refilling it.

EDIT: and yes, we reset the count after filling out documentation of the error if it is an isue... Like the time 20 lexapro mysteriously disappeared or when omeprazole kept disappearing over and over again. If narcs are off, they have to investigate but, in the meantime, we have to reset the count so that work can go on,

 

[R2pharmD2]

It forces the nurse/resp therapist to count what is in the drawer and enter it without telling her/him what the true count is so that if it is off, they will know when it happened (to find out who got the count all messed up). They do it for narcs, inhalation solutions and expensive meds (linezolid PO).

I wish some of our stuff was set up that way. Smart idea.

 

[owlegrad]

I wish some of our stuff was set up that way. Smart idea.

That is smart. Only our controls are setup that way, but I can think of some other stuff that would be good for.

Thanks for the info Lea. I meant after you run out of something do y'all ever reset the amount on hand so that you won't run out again? We rarely do. Of course we reset the count each time we fill it.

 

[All4MyDaughter]

What's up with all these P1s hijacking the residency application thread? 😛

 

[owlegrad]

What's up with all these P1s hijacking the residency application thread? 😛

Whew, glad you are not talking about me. 😀😉