Reflections – Cardiology

This was by far one of my favorite rotations in residency! Herb and the interdisciplinary team at SMH were amazing and incredibly supportive throughout my rotation. When discussing my patients, Herb would write out my patients’ medical conditions, medications and history on a board. This definitely made it a lot easier to draw connections between the progress in hospital and their medications.

During this rotation, I feel that I have gained a stronger understanding of various cardiac conditions, as well as, the evidence and key landmark trials. Aside from my objectives, other things I was able to improve on are identifying patient-specific goals, presentation skills, patient interviewing and chart documentation. These are things I can definitely still work on but with the help of Herb, I feel more confident in these areas and will continue to work on them in my future rotations/practice. Additionally, during this rotation,  Herb taught me how to perform physical assessments and learn how to interpret them. It was definitely exciting to be actually performing these assessments on real patients, instead of lab simulators! While a little daunting at first, making sure I did physical assessments whenever I had the opportunity to helped increase my comfort level and enhanced my ability to see my patient as a whole. All in all, this was a fantastic rotation and I will definitely aim to keep using the skills I have gained in future rotations! 🙂

Reflections – Psychiatry

Psychiatry is definitely a very different and complex field, and I am very fortunate to have such an experienced and knowledgeable preceptor to help guide me through psychiatry! 🙂 During this rotation, I had the opportunity to care for patients with various psychiatric disorders such as eating disorders, bipolar, and many more. Before this rotation, I had found psychiatry very daunting…and it’s definitely more of an art than a science as evidence in psychiatry often has various limitations. But, with the help of Gillian, I was able to develop a systematic approach to working up patients and identifying and comparing different therapeutic alternatives. Additionally, through our therapeutic discussions, I also gained a stronger understanding of common psychiatric disorders and was able to garner a lot of clinical pearls from Gillian. In my future rotations, I will continue to develop my knowledge and ability to perform therapeutic drug monitoring for common psychiatric medications (e.g. lithium).


Reflections – Clinical Orientation

The past 2 weeks passed by so quickly! I’m really thankful that our residency program has a clinical orientation as it allowed me to focus and build on my thought process and systematic approach. I was fortunate to have Mike who was very supportive and knowledgeable. The health care team at SMH worked closely with the pharmacists and were very approachable, which helped to enrich my learning experience

For my reflections, I plan to discuss how I have accomplished my objectives, as well as, make one new objective for each of them.

  1. Use the head-to-toe approach to assess my patients and if time provided, present at least 5 full patient work-ups to my preceptor (i.e. not just reading out the information I have gathered)

    Reflection: I used the head-to-toe approach to gather information and present all of my patients. With each presentation of my patient, I felt more comfortable with the head-to-toe approach and knowing which information was relevant to point out to my preceptor. I need to work on better presenting the progress of my patient in the hospital. In my OEE, I was taught to summarize the progress in one line. While that may work for patients who are newly admitted, for patients who I am encountering part-way through their hospital stay, capturing their progress in one line is challenging. For future patient presentations, I will try to summarize their progress while going through their head-to-toe (e.g. any trends in labs, etc).

    New Objective(s):
    – When presenting my patients, use the head-to-toe approach to summarize my patients’ progress, identify any new issues and highlight relevant trends. Do this for at least 5 more patients.
    – Consistently use the head-to-toe approach when gathering information and assessing all my patients

  2. Conduct at least 1-2 patient interviews in an organized and comprehensive manner
    – Have a list of interview questions ready prior to visiting the patient
    – Prioritize my interview questions in case time with the patient is limited
    – Make sure to also inquire about adherence, community pharmacy, family support, OTCs/herbals/supplements

    Reflection: Initially, my interviews were disorganized as I would jump from one condition to the next. My preceptor taught and provided me with an interview form that allowed me to conduct a proper BPMH and patient interview in an organized manner. I was able to meet my stated objective and always prepared a list of questions prior to visiting my patients. I will definitely not forget the most important question to ask — which is what are my patient’s goals from this hospital admission and expectations of their health care team!

    New Objective(s):
    – Document relevant information from patient interviews in a concise and organized manner in the progress notes
    – Delve further into patients’ responses (e.g. use questionnaires if a patient mentions they have a low mood) and tailor interviews toward my patients’ concerns and needs.

  3. Discuss with my  preceptor and write at least 1 clinical pharmacy note. Observe how my preceptor writes his clinical pharmacy notes and collaborates with other health care professionals and implement them into my practice.

    Reflection: I was able to get more experience writing SOAP notes. My preceptor would help point out situations where pharmacists would document a clinical pharmacy note. My notes tend to be wordy and at times, I would repeat information multiple times in my notes. My preceptor helped coach me on how to write clear, concise and organized notes. Currently, I still feel more comfortable drafting my note and reviewing it with my preceptor before writing it in the chart. Some useful tips were to include information from patient interviews or gather information from the bed-side nurse for the subjective, make sure you are not repeating details, write A/P in point form and always include your monitoring plan!
    FYI — Pharmacists are able to order non-prescription meds, continue medications PTA after verifying with the patient and another resource (e.g. P’net), labs and referrals to clinics.

    New Objective(s):
    – Independently assess the patients’ DRPs and clinical situation, and determine when writing a clinical pharmacy note would be appropriate (e.g. addressing a DTP and suggesting a care plan; discharge counselling; drug level monitoring). Draft up clear, organized and concise pharmacy notes and review with my preceptor prior to documenting it in the chart.
    – Become more comfortable and confident with my documentation skills

  4. Give 1 presentation. Practice my presentation at least 3 times while paying attention to my body language, tone and flow of presentation.

    Reflection: I facilitated a journal club for the first time, which was a great opportunity to brush up on my clinical appraisal skills and review non-inferiority trials. A more detailed reflection can be found in my procedure log. Reviewing it with my preceptor ahead of time helped better prepare me for my journal club and gave me a better idea of what to consider and research further on for future journal clubs.

    New Objective(s):
    – Prepare a cleaner and shorter journal club form
    – Have more questions prepared to facilitate discussion during future journal clubs

  5. Take opportunities to ensure continuity of care (e.g. with discharge counselling, communicating with the community pharmacy)

    Reflection: I was able to do a discharge counselling for a patient who was leaving nicotine replacement patches and a few medication changes. Although I was not able to do much discharge planning as most of my patients were still in the hospital when my clinical orientation ended, my preceptor and I helped prepare patients for discharge in other ways (e.g. asking what patients’ goals upon discharge, writing referrals, contact community pharmacies, medication reconciliations).

    New Objective(s):
    – Perform and document at least 5 discharge counselling during my general medicine rotation. Provide medication calendars and any useful counselling material.
    – Liase with community pharmacists and other appropriate health care professionals, in order to ensure a seamless continuity of care
    – Educate and connect patients with any necessary health resources during discharge (e.g. blister packing, special authority, insurance cards (e.g. Pfizer Strive))

On a random side-note…I recently watched Piper, a Pixar short about an unbelievably adorable little sandpiper bird (squee!) who leaves its nest to find food. I won’t spoil the story, but I found the beginning of Piper’s story to be similar to my start in residency where I’m starting to develop the skills and knowledge to be a clinical pharmacist. So, I’ll end my reflection with a picture of Piper in the beginning of its discovery of the world outside its nest: