Day in the Life of SPH PGY1 Resident
Perspectives from the PGY1 Residents through the Years
It is the beginning of residency, and I have been given the task of chief resident for the first quarter of the residency year. This was rather humorous, because I am probably the quieter resident of the group. With the challenge accepted, I went to work representing my fellow colleagues. I have had the opportunity to lead the weekly residency development meetings that take place every Wednesday from 2-4 pm. Planning for this involves meeting with Daniella, the residency coordinator, to formulate an agenda for the time allotment. Topics include any reminders that we, as a group, have on the imminent horizon. Open issues provide an opportunity to discuss any problems that need to be resolved. Finally, there is time for any topic discussion or group teaching where Jeff, the residency director, leads us through residency goals and progress so far. The role of the chief is to lead the meeting and document the minutes of what is discussed.
Another chief activity includes running weekly journal club on Fridays. This is always enjoyable, because it is the close of the week, and we are ending with some good group discussion about clinical research that could change practice. We use journal club to encourage these discussions so that understanding of a topic is enforced and we can potentially become more learned on new practices.
The best part of being chief is being able to represent your fellow co-residents. If there are any group issues or discrepancies, I am able to listen to what is being said and relay that information to whoever can fix the issue. Organizational skills also come into play. When emails need to be sent to everyone, it first comes to the chief who then shares it with the group. Through this experience, the role of being chief resident increases communication skills amongst colleagues and brings about better relationship.
By: Emily Falli, PharmD, PGY-1 Resident
It is 7 am on a Tuesday morning; I arrive at my residency office to prepare for a typical day during my cardiology learning experience. I start off my day by pre-rounding on all of the patients in the coronary care unit (CCU) and assigning my student patients to work up before rounds. Before rounds, the student and I go over all of the patients we worked up. We make our way up to the CCU and start rounds with the attending physician, nurses, and social worker. I answer any pharmacotherapy questions, and also make drug therapy interventions during rounds.
After lunch, I start preparing for the afternoon CHF patient discharge medication reconciliation and discharge counseling. My preceptor and I then go over each of the patients post discharge medications. We then go to the floor and counsel the patient on their medications, and also explain to them the importance of our heart failure clinic. Throughout the day, I also complete any pharmacy clinical consultations from physicians, physician assistants, nurse practitioners, and nurses.
This rotation has given me the opportunity to really grow professionally and I definitely feel comfortable going on rounds alone as the clinical pharmacist.
By: Huy Nguyen, PharmD, PGY-1 Resident
My morning starts in the Intensive Care Unit (ICU) at about 7:00am with prioritizing patients by their medication needs. Leading up to multidisciplinary rounds, the pharmacy team that consists of myself, the critical care pharmacist, and a student is present, collectively assess the appropriateness of patient medications. We make recommendations to providers and nurses either in advance of rounds or during rounds after determining the most recent patient care plan. Also, during this time, we field drug information questions from other members of the health care team in advance of rounds. Rounds last anywhere from 30-60 minutes, and provide another opportunity for pharmacy intervention or for other members of the team to request drug information. Afterwards, a plan is made for how patient care issues that came up on rounds will be monitored and addressed. The afternoon also allows time for topic discussions between myself, students, and the preceptor, and time for medication reconciliation or pain management consults requested from other units for which the critical care team is responsible. During this rotation I gained confidence in initiating drug related conversations on rounds and interacting with a variety of members of the health care team with regards to patient care plans. I also was able to assume responsibility for medication related issues and follow up with outcomes independently.
By: Pritpal Singh, PharmD, PGY-1 Resident
It is 3pm on a Thursday; I walk into the busy emergency department to see that most of the beds are full and in my head I know that tonight will be an interesting night. I make my way to the pharmacy desk and see that my preceptors Daniella and Lauren are in the middle of a conversation with their P4 student. Before I am able to sit down, Daniella and Lauren ask me; what are my thoughts of the drug regimen that the student came up with on a patient with possible aspiration pneumonia and positive urinary tract infection. I work the patient up and then analyze the student’s regimen and make my suggestions to the student and preceptors. Then we have an informal topic discussion on the different bugs and drugs for both aspiration pneumonia and urinary tract infections.
Once we are finished with our discussion, I start looking through the patient queue for patients to work up. I start by working up the possible stroke patient. I try to determine if the patient has any possible contraindications to TPA but before I finish, a nurse comes and tells us that pharmacy is needed in room 1.5. We walk in to see an A-fib patient with a heart rate in the 160s. The doctor starts giving verbal orders for a cardizem bolus and drip, I then go grab the medications, the infusion pump, and then finally program the pump for the nurse. After we finished getting the patient’s heart rate controlled, I resume looking into the patient’s possible TPA therapy. The patient’s lab comes back and there INR was 2.1 and we are unable to give the patient TPA. The rest of the night, we continually answer drug information and pharmacotherapy questions from physicians, physician assistants, and nurses.
During this rotation, I am able to practice as a clinical pharmacist in the emergency room. I have learned how to practice as a clinical pharmacist in many difficult situations such as code blues, respiratory arrests, opioid overdoses, rapid responses, arrhythmias and etc.
By: Huy Nguyen, PharmD, PGY-1 Resident
The infectious disease experience revolves around antimicrobial stewardship three days a week. The stewardship team includes the clinical pharmacist preceptor, a rotating group of infectious disease physician specialists, and the pharmacy resident.
Every morning I find culture results and vancomycin trough level reports waiting in my email inbox. Along with these data, reports for all patients on antibiotics from each unit are generated at 7:30 am every morning. On stewardship rounding days, we use these reports to identify cases of potential inappropriate or overuse of antibiotics. Floor by floor, we present the cases to the infectious disease specialist on rounds. If necessary, after a review of a patient’s chart, we leave our recommendations for the provider to consider discontinuing or narrowing antibiotic therapy.
Most days, I also monitor drug levels and cooperate with providers to address issues with vancomycin and aminoglycoside dosing and schedules, address pharmacokinetic consults, and assess patients for switching from intravenous to oral antibiotics. We also monitor the impact of stewardship, collecting data on whether or not our recommendations are accepted or rejected by our providers.
By: Jacob Patterson, PharmD, PGY-1 Resident
SURGERY AND PAIN MANAGEMENT
My day begins around 8 in the morning. I arrive at my desk and my first task is to check our consult queue. Here is where we will find all the requests for the pain management and surgery consults. I can see that we already have two preadmission testing (PAT) consults and a bariatric consult. The PAT consults involve post-surgery pain recommendations for opioid-tolerant patients. To accurately make recommendations, the consult will include assessing the patient’s current pain regimen, their current labs, their past medical history and the type of surgery.
We are often consulted for bariatric patients who will be unable to take tablets for a few weeks following their gastric bypass. Here we assess the patient’s medication list to determine which medications can be crushed and if they cannot, then we make an appropriate therapeutic substitution recommendation.
My phone rings and it is a nurse on 6MC asking us to come talk to her patient who is experiencing uncontrolled pain from a surgical procedure performed a couple days ago. The patient’s current pain regimen will be assessed as well as how often the patient is receiving their pain medications along with the corresponding decrease in pain score. We go upstairs to talk with the patient about their pain (i.e.: what type of pain are they having, how often, how their pain is after they receive pain medications, what makes the pain better or worse). Afterwards, I write up a consult detailing our interaction and assessment of the patient and any recommendations we make, making sure to follow-up with the patient’s provider.
Before I head back downstairs, I check the consult queue again and notice there are three new PAT consults and another pain consult. Off I go!
By: Kaitlin M., Farley, PGY-1 Resident
It has been 5 months since the start of the residency program, and I am currently progressing through my direct patient care Emergency Medicine clinical rotation. It is 4:30pm, and I am done with my rotation for the day. I am now waiting for my once a week staffing night starting at 5pm to begin. Once 5pm rolls around I head over to the inpatient pharmacy to begin my 5-9pm shift. My main focus is to collaborate with the other staff pharmacists and pharmacy technicians in order to ensure patient safety, and to provide patient-centered care by answering the phone, doing order entry, and checking medications. It is also important for me to focus on clarifying any incomplete orders with other healthcare providers, because I want to make sure that the patient receives the medications that they need on time. I am also continuously focusing on learning, and am doing so by tackling more difficult orders with the help of my staffing preceptor. My preceptor is my main resource for anything that I need while staffing, and she helps me work through a lot of things that I am still unfamiliar with at this early stage. My preceptor and I are constantly evaluating areas of strength and weakness in order to help me become a better practitioner, and we have both seen much progress since the beginning of the program.
When my weekend to staff comes around, the workflow is often very similar to the work flow during my once a week nighttime staffing shifts. The only difference between weeknight staffing and weekend staffing is that the weekend involves doing the normal order entry/staffing work, but also medication reconciliations, pain consults, and other clinical pharmacy consults. While I am entering orders, answering phone calls, and addressing incomplete orders I am also periodically checking for any new stat clinical consults to be completed. In addition to my staffing preceptor I also have available to me an on-call clinical pharmacist during the weekend. The on-call clinical pharmacist serves as a resource to verify my pain management consult recommendations before they are made, as well as help me work through any other consults/questions that I struggle in resolving. At the end of the weekend I create a handoff for all staff/clinical pharmacists describing unresolved issues from the weekend, as well as summarize all of the clinical interventions that I made.
My confidence only increases as I continue to collaborate with the staff pharmacists, my staffing preceptor, and the clinical pharmacists. I am progressing more and more each and every day that I am exposed to new order sets, and clinical consults. I have noticed that I have become more independent since the beginning of the program, and I am becoming more confident in my abilities as an independent practitioner as a result of the experiences that the longitudinal staffing rotation has provided.
By: Jessa Brenon, PharmD, PGY-1 Resident