Last rotation of residency! It is absolutely crazy how time has flown this past year. I am super excited for emergency, but am also nervous about whether I would be able to handle things “on the fly”.
My learning objectives are:
- Apply my knowledge from sodium/fluid balance to appropriate patients
- Have a systematic approach to addressing hyponatremia and hypernatremia
- Describe and build a systematic approach to Advanced Cardiac Life Support, Stroke, Toxicology and/or other commonly seen conditions in the ER
- Perform at least 2 physical assessments per week and interpret my findings to my preceptor
- Consistently state patient-specific goals of therapy when discussing my patients to my preceptor
- Overall, continuing to build my thought process and approach so that I am able to efficiently triage and work up patients in the ER setting
- Aim to have less reliance on paper and be more proactive to address issues in a timely manner
- Improve on ability to concisely document in a timely manner
- Speak at an easy to follow pace and volume for my presentation
I will be heading to St. Paul’s Hospital for a week of TPN! From our recent ADS on TPN, I’m expecting that this will be a very valuable, rewarding and challenging rotation. The following are my learning objectives:
- Competently evaluate the nutritional status of a patient. Determine the appropriate form of nutrition and set monitoring parameters to help determine when it is:
(1) no longer necessary, or
(2) appropriate to taper off TPN and transition to PO intake
(3) appropriate to taper off TPN and transition to EN
- Describe the available formulations and their differences/similarities.
- Competently and safely order electrolyte replacements for patients on TPN, and create an appropriate monitoring plan for them
- Describe how to approach TPN in patients with metabolic disorders (e.g. metabolic alkalosis, metabolic acidosis)
- Describe the different delivery methods and determine which is most appropriate in a given patient
- Describe commonly used equations and calculators and understand when and how to use them
- Describe the role of pharmacists in managing TPN
The following are the rotation manual’s learning objectives:
- Evaluate the nutritional status of a given patient.
- Determine the most appropriate form of the nutrition support required, if any.
- Estimate protein and caloric requirements of a patient based on the disease state.
- Design a suitable parenteral nutrition formulation for a given patient, allowing for compounding limitations of the pharmacy department, and medical conditions of the patient.
- Monitor nutrition support for potential metabolic, infectious, or technical complications, and recommend appropriate TPN formula adjustments to better meet nutritional needs or to prevent adverse effects.
- Identify altered nutrient requirements due to concomitant medications or drug-nutrient interactions.
- Demonstrate competence in discussing the pathophysiology, clinical features, and management of the following disease states/processes:
- Protein-energy malnutrition
- Refeeding syndrome
- Overfeeding from parenteral nutrition
I am incredibly excited to be heading to JPOSC this upcoming week for my ambulatory cardiology rotation. The following are my learning objectives:
- Perform at least 1 physical assessment per day and provide interpretations of my findings to my preceptor and team
- In particular, I would like to be able to comfortably and competently assess JVPs by the end of this rotation
- Be able to use available evidence (e.g. trials, PICO) to support my recommendations and to explain risk vs. benefits to my patients
- Complete the following procedure log: C3.5 R2: Prepare and deliver educational seminar to nurses, physicians or other allied health care members
I will be starting my ICU rotation at VGH tomorrow. I am a little nervous since it has been a while since I’ve had a clinical rotation. However, I am also super excited to be jumping back into patient care with ICU. From the calendar my preceptor has provided me, I expect that it will be a very challenging but definitely rewarding rotation. The following are my learning objectives:
- Continue to develop a systematic approach to working up my patients
– Consistently apply FASTHUG MAIDENS and review my patients in a head-to-toe approach when working through my patients
– Refine my process to ensure that I will not miss any MPs or DTPs
– Time my information gathering and work-up of all MPs and DTPs
(Goal is 2 hours, as per oral assessment standards – however, my priority will be ensuring that my work ups are comprehensive)
- Be able to describe the uses, different causes and monitoring frequency of common laboratory tests done in critical care patients
- Apply my knowledge from my Sodium/Fluid balance, Acid-Base Disorders and ECG academic day seminars, as well as, physical exam course
- Continue to develop my ability to document SOAP notes clearly and concisely
- If possible, perform a mock oral exam
- Continue to develop on my ability to prepare presentations (e.g. considering the audience, main take away points and how to best convey them) and deliver presentations, paying extra attention to my body language, pace and volume
- Meet rotation-specific objectives as outlined in the manual
Regarding my learning plan
- Do more procedure logs, as a means to document and reflect, and link them in my learning plan
- Review and reflect on my learning plan daily and document on a weekly basis
If possible, I would also like to complete the following procedure log(s):
- C3.5 R2: Prepare and deliver educational seminar to nurses, physicians or other allied health care members
- C3.5 R3(b): Demonstrate skill in the MODELING form of practice-based teaching
- C3.5 R3(c): Demonstrate skill in the COACHING form of practice-based teaching
I will be starting my Medication Use Evaluation rotation today and my personal learning objectives are:
- Improve and build a systematic approach to performing literature searches and critically appraising
- E.g. Gain more familiarity and use at least 2 different tools to perform critical appraisal
- Develop an approach to reviewing Cochrane Reviews and a template to submitting feedback for literature
Will continue to add objectives as the rotation progresses! 🙂
The following are the objectives from the manual:
- MUE Roles & Responsibilities
- Describe the roles and responsibilities of MUE within LMPS, including, but not limited to:
- Regional and local Pharmacy / Drugs and Therapeutics Committee support
- Pre-printed Orders creation and management
- Drug policy / protocol / guideline creation and regulation
- Evaluation of drug use through retrospective chart review, drug usage reports, etc.
- Formulary Management
- Define formulary management and discuss the components necessary for success.
- Describe the steps necessary for addition/deletion of formulary items.
- Outline possible methods of alerting pharmacy/medical staff of changes to formulary items, therapeutic alternatives, and cost saving strategies
- Drug Data Procurement
- Explain how drug data procurement can support decisions and improve pharmacotherapy in the institution
- Understand the DUE process including prioritizing target drugs, establishing DUE criteria, methods of intervention, implementation of programs, evaluation of patient outcomes & economic outcomes.
I will be starting my toxicology rotation at BC DPIC this week, and I am excited to learn more poisoning management. I think the knowledge and skills I will gain and develop during this rotation will definitely serve me well for my ICU and Emergency Medicine rotations later on! 🙂
My learning objectives are the following:
- Be able to navigate and use the BC DPIC website and the Poison Management Manual effectively to help approach patient cases
- Identify common toxidromes (e.g. anticholinergic, cholinergic, opioid, sympathomimetics) and list at least 3 possible causes, 5 signs and symptoms (in a head to toe format), as well as, any of their differentiating characteristics
- Be able to interpret anion gap, osmolar gaps, osmolality, acid-base laboratory values, in the context of a poisoned patient
I am excited to be heading to LMH for my drug distribution rotation. The following are my learning objectives:
- Develop a systematic approach to interpreting, assessing, checking, preparing and dispensing medication orders, according to organizational policies and procedures
- E.g. use medication profile, medical conditions, allergy history, relevant patient information, drug interaction checkers
- Be able to describe the automation technologies, medication use system and safe medication practices used in LMH
Procedure Logs I aim to complete:
- *3 x C3.2 R4(b): Accurately transcribe a medication order onto the medication profile or health record
- *3 x C3.2 R3: Prepare and dispense medications according to organizational policies and procedures
- 3 x: C3.2 R4(c): Clarify a medication order with a prescriber
The following are the learning objectives listed in the manual:
- Demonstrate the ability to locate source documentation outlining the legal requirements and professional standards that pertain to the distribution and control of drugs in health care organizations.
- Describe all legal requirements and professional standards that pertain to the distribution and control of drug sin health care organizations
- Demonstrate the ability to find and interpret 3 assigned FH policy and/or procedure documents relating to drug distribution and administration.
- Name 3 different types of drug distribution systems in place within FH. Describe the key principles of each system and list 3 advantages and 3 disadvantages of each of these systems.
- Describe 3 roles of the drug distribution process as a component of the provision of pharmaceutical care.
- Identify 3 potential drug-related problems that could occur within FH’s distribution system and identify 3 ways to prevent their occurrence.
- Describe 3 roles of pharmacy technicians and 3 roles of two other support personnel in the functioning of the drug distribution system. (e.g. tech, tech supervisor, nursing, unit clerk)
- Identify 10 patient-specific, real or potential, drug-related problems through the use of medication profiles and document the appropriate action taken to resolve these problems.
- State 3 benefits and 3 limitations of using a profile for pharmacotherapy monitoring and drug distribution.
- Demonstrate at least one process of medication incident reporting & analysis.
- Demonstrate the basic principles of aseptic technique under direct observation.
- Describe 3 advantages and 3 limitations of a pharmacy-based intravenous admixture service.
- Describe 3 specialized equipment used in an intravenous admixture service, including TPN, and describe 3 techniques and 2 aspects of the technology that may be used to increase efficiency and productivity of the service.
- Describe all precautions that are unique to cytotoxic drug admixture and delivery.
- Describe 3 other types of parenteral drug delivery systems and programs (e.g., PCA, home IV therapy, etc.)
Reference for CHPRB Level and Ranges: