APPE Rotation 5: Am Care
Pros: Working in a clinic doing DM/lipids/anticoag management is definitely great exposure to collabartive care practices and what some pharmacy could be. I don't think I really fully understood the whole picture of DM management until this rotation during which I would work up/counsel/make recommendatios on 3-4 pts/day. This really helped to solidify the guideline recommendations in my head on DM.
Cons: Pts often dont show up for clinic which makes for long, boring days. Some pts do show up but are unable to hold a focused conversation and thus makes the clinic meet less than beneficial.
General: I hate chronic conditions and am care as interventions generally take soooooo long to pay off/ be observable. However, I really liked the rotation as it helped me become more well rounded in assessing patients and making recommendations.
APPE Rotation 6: Internal Medicine
Pros: This rotation was very different than my ICU/CC rotation during which I worked up 16 pts daily. This rotation, I would follow very rudimentary basics like pud/dvt/crcl adjs on all the patients but only work up one patient per day. We would pick a patient and read review articles, guidelines, etc to be able to fully discuss the clinical picture the next day. It was a LOT of work, but I got more efficient at pulling better articles and self learning. I think this rotation has been pivotal in the process not due to it being internal medicine, but that the preceptor set the tone of demanding self learning to a degree way beyond previous preceptors (ton of disease states, drug monographs, and guidelines daily). I tend to think this helped to push me to perform as an independent practioner and prepare me for residency.
Cons: Only looking at one patient per day (wholistically) doesn't reflect the demands of the coming year in residency. Also wanted more of the pharmacist's perspective on how they approach each patient and a talk through on what they think about.
General: Hands down second best (after ICU) rotation based on the the strong push by the preceptor to make us into independently learning practioners.
APPE Rotation 7: Advanced Hospital
Pros: Lots of great things here. Very small hospital (30 beds) so I'm given the opportunity to input orders, charges, changes, etc. on a daily basis as an almost integral part of the work force. I also had the good fortune of being present during a computer software change for the initiation of bedside barcoding, implimentation of EMR, and changing of the pharmacy software. Its no EPIC, but it still has been a priceless experience at understanding how the foundation of it works and where issues arise with software and why (mostly the people in charge not fully understanding the software's proper usage).
Cons: Not a lot of evidence based medicine going on here. Can be trying at times when some practices are clearly from days gone by and not anywhere near the standard of care. I'll grant that one of the pharmacists entertains my questions about practices with a skeptical but listening ear.
Overall I'll note that the difference (in my experience overall) between having residency trained preceptors and non-residency trained is literaly night and day.
Next up: Infectious Diseases rotation!!!!!!
