The pursuit of “hAPPEness”
During our third professional year, my classmates and I had the exciting opportunity to peruse the rotation catalog that outlined preceptors, practice sites, and of course, specialty areas. T’was an exciting time indeed as we ranked our top 20 choices per requirement fields, such as faculty-acute care or community practice. I was unsure of which career path I wanted to pursue, so I aimed to tailor my rotations to offer me further insights into various practices.
I set a goal to choose rotations that were specialized in ambulatory care and clinical practice sites, so that I could learn more about how to apply my clinical knowledge to directly have an impact on patients. There was a 2-month period during which the computer system matched us to rotation sites, and the anticipation was daunting. Alas, I was disappointed to learn that I only received three clinically strong rotations out of nine, leaving me in a limbo as I now await to learn which site has availability to host me.
Nonetheless, I tell myself, “I will work hard, I will work to bring light to my profession, and I will make this experience the very best it can be.”
My second rotation in ambulatory care brought me to the office of a family physician who has been practicing for 17 years. Amongst his staff of medical assistants and physician assistants were two physician assistant students with whom I was partnered to evaluate and treat patients.
My partnership with the physician assistant students was very much a symbiotic relationship. While they demonstrated their process of diagnosing a patient, I was available to identify patient complaints that may be indicative of medication-related problems and suggest alternative medications or lifestyle modifications to resolve their chief complaint. Given the collaborative care setting, I was hoping to apply the physical assessment training I received in class to assess patients, which was predominantly done by my counterparts. After an honest conversation with my preceptor, I was able to approach my patients hands-on and evaluate them through blood pressure screenings, abdominal exams, and more.
Sometimes all you have do is be open and say, “I want to do more. I can do more.”
Cycle four took me to the emergency department (ED) in what once was America’s “Silk City,” but is now known for one of the largest disability populations and heroin distribution centers. I was excited to face the challenges of a health care provider in such a massive, urban setting and apply my clinical knowledge to improve patient outcomes. Given the high expectations I had going in for my first institutional rotation, I was left feeling disgruntled.
My time with the patients was limited and interventions I would have liked to have made were often retrospective. An open dialogue between my preceptor and I revealed that my preceptor had recently been charged with a new responsibility due to a co-worker resignation, which added on to existing roles as adjunct faculty, clinical pharmacist, and aggressive research coordinator for numerous studies. Turns out, my preceptor was also disgruntled with limited time with patients directly, so I continued my routine of asking questions and learning as much as I could about the role of an ED pharmacist.
There is a bright side. I was challenged intellectually with daily topic discussion and patient case evaluations, and the experience was diversified with weekly conferences during which I was able to hear medical residents present their journal clubs and ED attendings present the monthly M&M (Morbidity & Mortality) medical error case. The highlight of my rotation was when I had the opportunity to attend a monthly toxicology and poison control center conference where physicians, pharmacists, toxicologists, botanists, and many more intelligent individuals came together to analyze the strange poison management cases from the previous month. I was elated to hear the clinical pharmacist offer her input on how the patient toxicity was managed improperly and could have been treated more appropriately.
Looking forward to the future
The pursuit of “hAPPEness” is not yet over! I still have rotations in organization management, managed care, and community practice. While I have not yet felt the intense passion and excitement of “this is what I want to do,” I am hopeful for what has yet come to pass. Each day is a new opportunity to help my patients directly or help myself become a better provider for my patients.
Often times, rotations are assigned through computer-generated matches, which means you might not have a rotation in your areas of interest. Despite showing up with a positive attitude, extensive preparation, and willingness to learn, something falls short of incredible. So, I turn to our Preceptor Feedback author. What advice do you give to students who have had three to four rotations so far, but have not felt the surge in passion? What might be the tipping point for student pharmacists who linger on the boundary between “this is interesting” and “I cannot wait to do this again tomorrow or maybe even in the future!”