Kristina Kozlovsky, Rx2018 - Cambridge
Navigating the region
There were some obvious perks to completing my clinical rotations in the Kitchener/Waterloo region: I already had a place to live (and I knew there were a lot of subletting options available as well), I was familiar with the area and all of its amenities, I enjoyed living in the area, and I had people I knew nearby. There were also other reasons I enjoyed my region, which also factored into ranking it highly in my regional preferences. First, I was familiar with a lot of the different sites that I would potentially be placed in and felt that I would be in a region with many fantastic preceptors that would provide me with really good learning opportunities. I was definitely not disappointed and felt that the part about my region that I liked the most was the invaluable experiences I got from it and my preceptors. I also knew that the area was not overwhelmingly large and that my commutes would be really reasonable, either by car or the extensive transit system that I know exists in the area. My placements were in Cambridge, which was close to enough to commute to from Kitchener so that I didn’t have to move.
I am a big proponent of school/work/life balance and so I definitely encourage future pharmacy students to find hobbies and fun activities in their region. While clinical rotations were rewarding, there were also be days that were stressful and that left my mind exhausted. It was important for me to take time to de-stressing and for self-care, and finding something to do that I enjoyed and made me feel good helped both with my mental health and my performance at each placement. I encourage students to find as much work/life balance as they can while on rotations.
For me, going to work out at CrossFit Kitchener really helped keep my life in balance. It was a way to stay in
Lastly, I also felt comfortable reaching out to my Regional Clinical Coordinator (RCC), who I knew would be very involved and responsive if I had any issues or concerns. I encourage students to consider multiple factors when deciding how they will rank their region preferences, and also keep in mind that there is something to enjoy and appreciate about each region.
Practice site descriptions
My first site was at Preston Medical Pharmacy, a highly clinical community pharmacy that offers services such as immunizations, diabetes foot care clinics, INR point-of-care testing, and BpTRU blood pressure testing. The pharmacy workflow has been designed so that pharmacy technicians ensure all of the technical accuracy checks and the pharmacists and would focus solely on the clinical aspect of medication distribution. The pharmacists would also spend most of their time in appointments (there were three separate rooms for patient privacy), performing MedsChecks, follow-ups, Pharmaceutical Opinions, smoking cessation counselling, and clinical assessments (INR, blood pressure, blood glucose, etc.). I was able to enjoy all of the above in addition to spending a lot of time researching and writing Pharmaceutical Opinions, which gave me a lot of opportunity to practice thinking clinically and making meaningful changes to patients’ drug therapy. The pharmacy also services two local hospices so I was able to experience going on bedside rounds and learn more about palliative care by working with the palliative care doctor on a presentation to hospice clinical staff.
My second site was at Cambridge Memorial Hospital (CMH), working on one of the two Medicine floors. On a daily basis, I worked closely with my preceptor, who was the Medicine floor pharmacist, as well as the pharmacy technicians and pharmacy students who worked diligently on completing Best Possible Medication Histories (BPMHs). My daily routine consisted of printing a list of patients currently admitted on the floor and their medications, performing medication work-ups to identify any drug therapy problems and consider possible solutions, and performing drug monitoring (for example, following medication doses and renal functions overtime for patients on renally-cleared anticoagulants or antibiotics). Later in the morning, we would attend bedside patient rounds along with nurses, physicians, physiotherapists, and social workers, where we followed a structured discussion that allowed pharmacy to present any drug therapy issues. The rest of the day was spent addressing other drug therapy issues not addressed on rounds, monitoring patients, making recommendations to physicians, helping with the more complex BPMH and discharge processes, and counselling patients. CMH, like other hospitals, has informally focused on better managing patients with conditions that lead to high re-admission rates, including heart failure (HF). I was able to help the pharmacy staff with the endeavour by presenting on HF information relevant to hospital staff and creating a monitoring sheet for patients newly diagnosed or those with HF as their reason for admission.
My last placement was at Rexall Canamera, where I worked with a wonderful, upbeat group of pharmacists and pharmacy assistants. Rexall Canamera has an opportune location in a medical centre complex, with family physicians and a general surgeon next door, and many other physicians and specialists in the nearby parts of the complex. There was also a medical imaging service, a LifeLabs, and a family health team, all of which brought in a lot of patients with complex medical histories and medications, many of which were seniors. My role was typical of most community pharmacy practice placements – I spent most of my time checking prescriptions, performing MedsChecks and Pharmaceutical Opinions, and counselling patients on OTC and prescription medications. The unique aspects of the placement involved a strong working relationship with the physicians in the area, which gave me the opportunity to make many recommendations, as well as taking a lead and handling everything involved in the valsartan recall.
The most valuable skills I gained from my patient care rotations truly revolved around my ability to provide patient care (shocking, I know). This experience instilled confidence in my ability to take the things I learned in the classroom and apply them to actual clinical situations, which was not something I had a lot of before starting. I had many valuable opportunities to do patient work-ups to identify and solve drug therapy problems, counsel patients, perform hands-on clinical work (INR testing), work closely with other members of the health care team, and research and learn on my own as well. I obtained the confidence in my clinical skills that I needed, and this has made me feel more prepared to be a pharmacist than I have ever felt before.
Some of the resources I found most useful included Up-To-Date, RxTx, Lexicomp, and the Mums Anti-Infective guidelines, among many of the other resources provided by professors in IPFC for clinical topic-specific resources.
One of the most useful resources I discovered on clinical rotations was on Micromedex (accessible through the School of Pharmacy Library). If a pharmacy student, pharmacist, or physician or other HCPs need to know whether a sign or symptom a patient is experiencing could be caused by a medication they are taking, they can simply type that symptom into Micromedex and it will generate a list of medications that can be associated with that side effect and the evidence to go along with it. For example, I had a physician ask me if a patient’s medications could be causing her recurrent pancreatitis so I searched “pancreatitis” in the search box, and an option in the drop-down menu became “drugs that cause pancreatitis” and I was able to present the possible drugs and their likelihood based on available evidence.
I was also very fortunate to have preceptors who acted as some of the most valuable resources and were always very receptive to answering my questions and teaching me. That being said, preceptors can be very busy, so students want to make sure that when they’ve gone to them for help that they’ve attempted to answer the question beforehand. This shows their preceptor they are willing to put the work in and makes for a more productive discussion.
Oh – and friends!! Whether it’s in school, on rotations, or beyond when working as a pharmacist, I highly recommend students turn to friends and colleagues that they can work with to answer questions as well.
Advice for future students
My first piece of advice for students is to stay positive and open to every opportunity they get to have while on rotations. Placements may pleasantly surprise them and could easily influence where they want to work as a pharmacist (it did for me), so they shouldn’t shut themselves off before they’ve even gotten there. Staying positive also makes the experience a lot more enjoyable.
My second piece of advice is to work hard and be proud of the amount of effort they put into their role at each placement. If they show their preceptor right off that bat that they are willing to work and learn, preceptors will often reward them by giving them more opportunities and teaching them. If they’re really lucky, some of their preceptors will provide them with references or maybe one of their placements could easily turn into a place of future employment.