Collaborative Teaching Unit Internal Medicine Rotation Oct 12th to Nov 6th
Final week
During my last week I presented my case (see comments below) and finished my Kinetics cheat sheet. I also helped the team to organize a complicated discharge by finding out how a patient can get medications covered while in the process of applying to Pharmacare. I also used some of my knowledge from a recent therapeutic talk to advise a resident on what non-drug therapies (family to orient patient, clock, photos from home etc.) and medications to use in an acutely delirious patient. I feel like this last week has gone by so fast, I really enjoyed this rotation and rounding with the CTU team!
3rd week
This 3rd week has gone by fast! This week I presented my Journal Club (see reflections below) and have continued to prep for my case presentation next week. I have also had discussions about diabetes, vanco & gent and have been working on finishing up my kinetics cheat sheet. I have also worked up new patients with pneumonia, acute gout and NSTEMI and have been involved in their discharge planning. Finally, Friday was a busy day where I helped consult the team on an NSAID allergy, pancreatic enzymes and dyslipidemia. The consult on the NSAID allergy to diclofenac was interesting, I had to interview the patient to determine the kind of reaction that she had in the past. I came to the conclusion that it was anaphylaxis (SOB, swelling, redness, hives) and then researched some primary literature to determine what this meant. I learned that she would be anaphylactic to other NSAIDs with a similar structure to diclofenac. I also learned that there is 2 kinds of NSAID induced reactions, one that is mediated by IgE causing anaphylaxis, and another from blockade of COX 1 causing urticaria and NSAID induced asthma. This consult was a great learning experience!
2nd week
This week I have assessed 2 new patients and practiced leaving notes in the chart for the team. I have also practiced my interview skills and been involved in one discharge. This week we also discussed varices in liver cirrhosis, acid-base imbalance and started to talk about diabetes. I have also worked on evaluating Journal articles. I am preparing for my Journal club in week three and have evaluated my first non-inferiority trial. This has been a big learning curve for me and has helped me to work towards my 4th goal for this rotation. Finally, I ended week two by attending the first set of case presentations in Vancouver.
1st week
This week has been very different from my last rotation. So far I am finding that acute care is a less controlled environment and that changes in the patients status occurs much faster then on the geriatric ward. I have started workups on three patients this week but in two of the cases I was only able to assess the patient based on labs, PNET and consults. I was not able to interview either patient and solve their DRP’s because one patient was transferred to another teams care and the other discharged himself from Emerg. My third patient is hopefully one that I will get to workup with an interview, solve DRP’s and provide follow up. In addition, I have attended rounds this week and have practiced presenting one patient to the Pharm D student. I have also done some readings on DVT prophylaxis and COPD. I have chosen an article for my Journal Club and will hopefully find my case presentation patient early next week!
4 Personal goals that I want to achieve during this rotation:
1-Continue to work on concise SOAP notes and increasing speed when formulating the notes
2-Become more familiar with chosing antibiotic therapy based on organisms known to be present in the infection
3-Practice pharmacokinetic monitoring of IV antibiotics
4-Become more familiar with evaluating evidence for Journal Club and Final Case Presentation
Journal Club October 28th:
Good things
-Critique was integrated into conversation about each part (design, population etc.)
-Good handout, lots of information on study and how to interpret results
-At end was more relaxed and talked slower and involved the group more
Improvements
-Should talk slower at the beginning and involve the group more
-Make a strong conclusion as to what I would do with the results of the study
-Expand on BNP and explain its use in diagnosing HF
-Did not talk enough about the graph, I knew more about it but didn’t spend time on the details
Case Presentation November 5th Mr JE
Internal medicine Case Presentation
Today’s presentation went well. I think that my pace was good and my timing was just as I had practiced. I was also pleased that I had anticipated more of the questions I got asked, this is something I haven’t done as well in previous presentations. I did have the answers to some questions (risk of VTE in general medical patients, benefit of dalteparin, why I chose to start dalteparin etc.) and others became a group discussion. An improvement for next time would be to make my monitoring plan more specific as to what I would monitor as a pharmacist and not just what other staff could monitor.
