Typical day in an acute care rotation? Rotation do-over?

[stark3]

Whats a typical day on rotation like on an acute care rotation? I am going on rotations soon and have some amazing teaching hospitals lined up and wanted to know what to expect.

1. Also, if you completed your rotations recently, there is a learning curve as you transition from didatics to rotations. What do you wish you knew straight from the beginning that would allow you to be more polished/stand out?

2. If you are a preceptor, tell me about some characteristics/qualities that your top rotation students exhibited.

TY for the advice!!

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[PolarPop]

Typical days vary by rotation site, it could be as early as 6 am and can go as late as 6 pm. In general though...

1. Don't ask questions you can look up on your own

2. Get a drug reference app on your phone and ask when it's okay to use it (micromedex at least, lexi is best - some hospitals/schools have free lexi you can download on your phone)

3. Never guess on rounds, and always follow up with anything you couldn't answer. Be concise about it

4. Download and review guidelines relevant to the rotation. You can't reference your therapeutics notes for rounds

5. Download and review hospital formulary/antimicrobial stewardship policies

6. If it's gen med/ICU/ID rotation buy a sanford guide and carry it with you

7. Develop your own system for working up patients so you don't miss things, this usually changes slightly for each rotation due to preceptor preferences. You might need to use a patient work up sheet for the first rotation until you get better at it.

8. Carry whatever cheat sheets you think you will need, opioid conversion tables, antibiograms etc.

9. Get comfortable with the medicine teams ASAP

10. Relax, eat breakfast, don't be late, don't talk back, all the other basic things that shouldn't have to be said

 

[anofuyu]

With teaching hospitals, you'll have rounds in the morning typically. For my ID, I went in around 530-600 every day to work up patients and get all the vancomycin/AG dosing done before round (depending on how many patients I think will be there that day). The day ends at 1600 when my preceptor leaves, but I stay behind to work on follow-ups with providers, etc. It would be helpful to review labs (normal ranges, abnormal values, what labs to watch for in what disease state) and have normal labs ready for reference with you on rounds.

The biggest transition I had to make was making decision. Usually you can't make recommendations like "if x happens then y", and give 10 different options - this doesn't help the provider decide. You should have the best option that you really want to go through, based on your clinical judgment, and an alternative option in case your "best" option doesn't agree with the provider. As my preceptor says, "Always have a backup plan"

If you are planning to apply for acute care residencies, keep track of good recommendations that your preceptor commends you for; you will be asked to give examples during interviews (you can google pharmacy residency interview questions to get an idea). I regret not writing down all the good recommendations I made; regardless of how vivid they might be at the time you make them, you tend to forget not long after.

 

[stark3]

Typical days vary by rotation site, it could be as early as 6 am and can go as late as 6 pm. In general though...

1. Don't ask questions you can look up on your own

2. Get a drug reference app on your phone and ask when it's okay to use it (micromedex at least, lexi is best - some hospitals/schools have free lexi you can download on your phone)

3. Never guess on rounds, and always follow up with anything you couldn't answer. Be concise about it

4. Download and review guidelines relevant to the rotation. You can't reference your therapeutics notes for rounds

5. Download and review hospital formulary/antimicrobial stewardship policies

6. If it's gen med/ICU/ID rotation buy a sanford guide and carry it with you

7. Develop your own system for working up patients so you don't miss things, this usually changes slightly for each rotation due to preceptor preferences. You might need to use a patient work up sheet for the first rotation until you get better at it.

8. Carry whatever cheat sheets you think you will need, opioid conversion tables, antibiograms etc.

9. Get comfortable with the medicine teams ASAP

10. Relax, eat breakfast, don't be late, don't talk back, all the other basic things that shouldn't have to be said

Thanks for the response!

When you say follow up with something you can't answer, how quickly are you supposed to follow up? Same day ? Next day?

 

[stark3]

With teaching hospitals, you'll have rounds in the morning typically. For my ID, I went in around 530-600 every day to work up patients and get all the vancomycin/AG dosing done before round (depending on how many patients I think will be there that day). The day ends at 1600 when my preceptor leaves, but I stay behind to work on follow-ups with providers, etc. It would be helpful to review labs (normal ranges, abnormal values, what labs to watch for in what disease state) and have normal labs ready for reference with you on rounds.

The biggest transition I had to make was making decision. Usually you can't make recommendations like "if x happens then y", and give 10 different options - this doesn't help the provider decide. You should have the best option that you really want to go through, based on your clinical judgment, and an alternative option in case your "best" option doesn't agree with the provider. As my preceptor says, "Always have a backup plan"

If you are planning to apply for acute care residencies, keep track of good recommendations that your preceptor commends you for; you will be asked to give examples during interviews (you can google pharmacy residency interview questions to get an idea). I regret not writing down all the good recommendations I made; regardless of how vivid they might be at the time you make them, you tend to forget not long after.

Thanks for the reply! In terms of the transition from didatics to rotations, how ready did you feel? I do well enough in class but if you put me on the spot, I feel like I might not be able to answer quick enough.

 

[John Detter]

Thanks for the reply! In terms of the transition from didatics to rotations, how ready did you feel? I do well enough in class but if you put me on the spot, I feel like I might not be able to answer quick enough.

I don't want to be a downer, but realistically you're going to be in many situations where you do not feel prepared in terms of knowledge. But that's not a bad thing since good preceptors will intentionally throw odd questions your way in order to get you to learn things that they do not teach in the classroom or get you thinking critically instead of reciting a memorized answer to a question. The best you can do is keep asking yourself questions as you're working patients up. This was a little difficult for me at first until I learned to anticipate what my preceptor or team would want to know.

And if you're placed on the spot and you don't know the answer, there's no issue with saying "I'll get back to you on that." Just make sure you follow through in a timely manner. You'll get to see in practice that your preceptors will encounter many things that they don't know or have never dealt with, and they will have to research the answer as well.

 

[anofuyu]

@stark3: yep, I also did well in my courses but being on rotation is a completely different story. I feel like I knew things well enough to get the correct answer on a MC exam, but I can't explain most concepts from A through Z (and like someone already said, you can't guess when you talk to providers, it's better to say you don't know and go look up the answers). I also meant to review my spectrum of activity for common abx, of course that never happened so I did struggle a bit during the first two weeks. Most preceptors don't expect you to know things off the bat though, so don't stress too much. Just show them you're willing to go the extra miles and always try to improve.