Reflections on Clinical Orientation

First clinical rotation complete!! The CTU was awesome, the medical team was receptive, and the St. Paul’s pharmacists were welcoming of us residents. Although the intent of the rotation was to keep it focused on developing a process and not so much delving into therapeutics, I found myself learning a lot through working up various patients. Already by the end of the rotation, I felt like I was just hitting my stride in information gathering, and have begun to crystallize a process in formulating plans. What I still need to work on overall is creating concrete and executable plans for all the medical problems that my patient has, although prioritizing them has not been a challenge as of yet. So, how did I do on my goals?

Goal #1: Holistically incorporate radiographic findings and be able to apply them to rationalize diagnoses to better develop a pharmacotherapeutic plan – I believe I have met this goal. I did look up any terms I did not understand, and used reasoning from a diagnostic test (a CXR) to rationalize that what I was seeing (in one of my patients who had CHFpEF and a query pneumonia) was more likely a pneumonia and as such should be treated based on those findings and her symptoms. This helped me better understand the medical team’s plan.

Goal #2: Become proficient at performing medication reconciliation, and proactively take action to resolve any discrepancies – During this rotation I did not get to take part in an observed medication history. However, given the characteristics of some of my patients, whether there is a language barrier, or medical literacy was low (so they did not know what they took/why they take medications/how often each medication is taken), or uncooperative patients, I became better at taking focused medication histories for the information that I most urgently needed. One example was planning a discharge for a patient who took various traditional Chinese herbal products. This patient was also on warfarin, so I had to take a quick history of her NHPs and determine if any of them interacted with it. In my future rotations, I look forward to being involved with reconciling medication histories alongside the physicians.

Goal #3: Be able to work up a relatively simple patient (<6 medical conditions) in under 3 hours – I don’t think there was a patient that I had who had <6 medical conditions during Clinical Orientation! Such is the life in CTU. However, I found that with each subsequent workup, I became more efficient in gathering pertinent data. I look forward to working on my efficiency further and being more efficient in getting up to speed on medical conditions that I may not have seen before. I did keep therapeutics notes in a notebook and wrote down things I may need to unpack later.

All in all, it was an enriching rotation and I look forward to continuing to build and refine my process.

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