Category: Rotation Objectives

Goals and Objectives: Emergency Medicine rotation

On the eve of the new year, I find myself actually apprehensive of this upcoming rotation. Having been off a clinical rotation since early November, and despite great experiences at DPIC and with the Therapeutic Initiative, I still feel out of practice with the process. The mock oral exam was also a kick in the behind for me; I hope that this upcoming rotation will allow me to further hone the tools that I have acquired and also streamline my process.

I’m also quite fond of documentaries, in any shape or form, and I often watch them to relax (my friends think I’m crazy). One such documentary I came across was Emergency Room: Life + Death at VGH, which follows the frenetic, hectic careers of the emergency physicians, nurses, and allied health in the VGH ED. Am I excited? Of course! Those folks are experienced and seasoned; hopefully I can learn a lot from them without getting in their way :D.

Goal #1: Gain a better understanding of the role of the pharmacist in the Emergency Department beyond medication reconciliation. Objectives to meet this goal:
– Complete all medication reconciliation procedure logs by the end of this rotation
– Shadow at least 2 other allied health in the ED, including EMS if possible

Goal #2: Become proficient in condensing information for patient handover from Emergency to ward pharmacist. Objectives to meet this goal:
– Continue to hone process and deliver a patient presentation to preceptor without “jumping” back too often

Goal #3: Be able to provide recommendations on workup and pharmacotherapy for the most common conditions/procedures in the ED, e.g. acute pain, stroke, seizure, ACS, arrhythmias, tox overdoses, sedation. Objectives to meet this goal:
– Quality over quantity: no trying to learn all conditions at once!
– Learn by doing: by week 4 of rotation, be proficient at handling 50% of practicing ED pharmacist patient load
– Be able to distinguish based on clinical presentation and radiological findings, between conditions that may mimic one another or cause one another, such as ischemic stroke and hypoglycemia, or hyponatremia and hypoglycemia causing seizure.

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Goals and Objectives: Medication Use Evaluation rotation

It is now time to apply what I learned during EBM week, but through the lens of a pharmacist on a Therapeutics committee. I come in with preconceived notions that this is an extension of EBM week, and I hope to strengthen my critical appraisal skills and bring that to further rotations and my practice.

Goal #1: Develop a robust process for evaluating the quality of an RCT and whether to proceed with further critical appraisal. Objectives to meet this goal:
– Have a flow of 1st aspects to evaluate when approaching an RCT
– Practice: evaluate a ton of RCTs during the two weeks

Goal #2: Become familiar with various methods by which study authors present statistics and data to influence the reader to come to the same conclusion as the authors. Objectives to meet this goal:
– Be able to list sources of bias outlined in the Cochrane handbook
– Be able to explain 2 common methods for statistical analysis for RCTs and the shortcomings with each analysis

Goals and objectives: Toxicology rotation

Goal #1: Develop an approach to evaluating the poisoned patient. Objectives to meet this goal:
– For each toxidrome, have a framework for which abnormal lab findings, signs and symptoms I would expect to see, head to toe
– Work on obtaining collateral for which substance was ingested and timeline from ingestion
– Become familiar with various laboratory and radiologic findings for ingestion of certain toxins

Goal #2: Become confident in providing triage, and if applicable, recommendations for ingestion of a variety of toxins. Objectives to meet this goal:
– Come in with prior knowledge of how to navigate the DPIC Poison Management Manual efficiently
– For common poisoning agents (acetaminophen, TCAs, ethanol, polyethylene glycol, etc), be able to describe the toxidrome and severity of each agent.
– Be able to address the elements of supportive care (i.e. https://lifeinthefastlane.com/fast-hugs-in-bed-please/ – FAST HUGS IN BED PLEASE) in the poisoned patient

Goals and Objectives: Infectious Diseases and Antimicrobial Stewardship rotation

Goal #1: Develop a framework and approach to assessing the patient with a suspected infection. Objectives to meet this goal:
– Develop a head to toe approach to evaluating whether the patient actually has an infection or not
– Know the common clinical and radiographical presentations for pneumonia, cellulitis, infective endocarditis, sepsis, UTI, septic arthritis, and osteomyelitis.
– Develop a monitoring plan to assess drug therapy for each intervention made during my time on the AMS service.

Goal #2: Begin to have a framework for correlating clinical presentation to specific microbiological etiologies. Objectives to meet this goal:
– For each infectious syndrome, where it is possible, acquire knowledge on distinguishing factors on radiography or clinical presentation that would differentiate between different causative pathogens.
– Attempt to interpret dictations from 1-2 X-rays or CT scans, i.e. “pulmonary infiltrates”, “ground glass lesions”, per day.

Goal #3: Develop a convincing yet professional approach to communicating interventions from Antimicrobial Stewardship to physicians and other health professionals who are most responsible for the patient.
– Practice, practice, practice. Become involved in that aspect of the service.
– Incorporate pharmaceutical teaching into interventions.

Goals and objectives: Medicine rotation

A bit late posting this…first couple days on CTU Pink at St. Paul’s has been busy! It’s certainly interesting what rolls in through the door and the different issues that come up. Here are the goals I set for myself prior to starting the rotation..mostly borne out of the feedback I received from BCCA in regards to my process:

Goal #1: Improve my ability and confidence to provide verbal recommendations to the team. Objectives to meet this goal: 

  • Attend team bedside rounds and have my recommendations ran by my preceptor and ready to go by then
  • Structure my rationale in terms of efficacy and safety
  • Have a plan B recommendation prepared in case my first one is not accepted with a good rationale

Goal #2: Be more comprehensive with my alternatives list for resolution of DTPs. Objectives to meet this goal:

  • Include and consider continuing current management, or different doses or dosing forms of medications in my alternatives
  • Do not leave a DTP without a medical issue attached to it, e.g. adjust the bowel protocol for renal dysfunction, attached to AKI as a problem

Goal #3: Become more systematic in gathering info and reporting in regards to daily updates. Objectives to meet this goal:

  • Utilize the same format and process in updates as in the initial workup, e.g. ROS, vitals, labs, new problems, DTPs, alternatives, plan
  • Consistently solicit feedback from preceptor on how to streamline thought process to be more comprehensive

Goal #4: Develop a strong knowledge base on the most common set of conditions that are encountered on a general medicine ward. Objectives to meet this goal:

  • Seek out new opportunities to fill in gaps in knowledge; personally, substance abuse disorders and acute conditions not well covered in the undergrad curriculum, e.g. CHFE, DKA, sepsis, hepatitis C
  • Perform personal mini didactics on unfamiliar conditions, structured similarly to how conditions were learned in pharmacy school, e.g. pathophys, lab and physical, treatment alternatives, landmark trials/evidence, monitoring
  • Continue to record nuggets of knowledge in notebook to reconcile with previous knowledge of conditions, and reflect how one would treat the condition with differing circumstances

I look forward to further developing my thought process and being more confident in formulating plans.

Goals and objectives: Oncology rotation

I’m anticipating a big jump from Clinical Orientation right into Oncology, and I hope that the previous very very basic knowledge I gained from the oncology elective in undergrad will be activated so I can build upon it and apply it in a meaningful way!

Goal #1: Develop a head to toe approach to assessing a patient for adverse drug events secondary to chemotherapy, or supportive agents for chemotherapy.
Objectives to meet this goal:
– Assess 3 patients per week, head to toe, for ADRs as practice.
– Develop a “hit list” for treating various ADRs from chemo, such as neuropathy, nausea and vomiting, and hand-foot syndrome
– Document in the chart my findings based on this assessment for at least 2 patients per week.

Goal #2: Be able to provide executable recommendations upon demand for proactive nausea and vomiting management based on the BCCA protocol the patient is on.
Objectives to meet this goal:
– Know 10 chemotherapy agents that automatically qualify a regimen to be “highly” emetogenic as per BCCA protocols and the Hesketh algorithm
– Be able to rationalize changes to nausea and vomiting prophylaxis and treatment based on patient response from previous cycle of chemotherapy
– Provide recommendations to the team for nausea and vomiting management for at least 2 patients per week

Goal #3: Develop a process for counselling oncology patients on either a new chemotherapy regimen or supportive care medications.
Objectives to meet this goal:
– Counsel at least 1 patient per week on supportive care medications that they will bring to a community pharmacy
– Counsel at least 2 patients per week on a new chemotherapy regimen as per BCCA protocols
– Ask for feedback on counselling skills in the oncology clinic setting from preceptor after each session.

Goals and objectives: Clinical Orientation Rotation

Looking forward to my first foray into patient care this residency year. I will be working with Dr. Michael Legal and I will be paired up with my fellow resident, Puneet (follow the link to his blog!). I hope that I will develop somewhat of a foundation to tackle my next clinical rotation, which is oncology…and should be a steeeeeep learning curve indeed.

Goal #1: Holistically incorporate radiographic findings and be able to apply them to rationalize diagnoses to better develop a pharmacotherapeutic plan.
Objectives to meet this goal:
– Look up any words that do not make sense on a dictated interpretation of any radiographic investigations
– Present any radiographic findings as: what was found, and why that points towards a diagnosis (or why not)

Goal #2: Become proficient at performing medication reconciliation, and proactively take action to resolve any discrepancies.
Objectives to meet this goal:
– Obtain a relatively simple BPMH (5-10 medications +/- 1-2 OTCs) in under 10 minutes
– Be able to rationalize to my preceptor any action to resolve discrepancies
– Be able to write a succinct (<1 page) clinical note in the patient record on a MedRec clarification

Goal #3: Be able to work up a relatively simple patient (<6 medical conditions) in under 3 hours.
Objectives to meet this goal:
– Develop a flow to gathering information, starting with the chief complaint and HPI first
– By the end of the rotation, develop my personal workup sheet for further clinical rotations
– Continue to keep a notebook outlining conditions I do not know and to be transcribed to electronic form later (repetition solidifies knowledge for me!)

Goal 1 was borne out of a weakness that I found during my hospital rotation in undergrad based on feedback I received, and goals 2 and 3 were due to them being necessary competencies I must carry forward in my residency training. I look forward to starting my clinical rotations!

Goals and Objectives: Evidence-based Medicine Rotation

Goal #1: Develop an efficient process for appraising a variety of literature, including RCTs, observational studies, meta-analyses, systematic reviews, and guidelines.
Objectives to meet this goal:
– Remain engaged during the didactic sessions and ask questions of my colleagues and the facilitator where necessary
– Develop a “hit-list” of 3-5 elements to look for in a paper or guideline to determine whether the evidence is applicable to a patient under my care, and whether I should continue appraising a paper before moving on to the next one
– Develop a “hit-list” of 2-3 elements to look for bias or systematic weaknesses in a paper or guideline to efficiently triage papers for more extensive review

Goal #2: Develop a process to approaching clinical dilemmas and treatment choice with patients.
Objectives to meet this goal:
– Develop an approach to elucidating patient values within the first 2 minutes of a patient interaction
– Endeavour to use zero medical jargon during each patient interaction, and to explain medical jargon not previously clarified
– Present at least 2 alternatives and 2 pros and cons for each treatment option, and develop a process to develop these pros and cons based on patient values

Drug Distribution Rotation Goals and Objectives

Starting on June 19th, I will be based at Eagle Ridge Hospital in Port Moody for my Drug Distribution rotation. I am excited to get the residency year started! I hope that my experiences in the dispensary at Eagle Ridge and at other hospitals during 3rd week visitations will give me a framework to keep in mind logistical concerns when providing care during my clinical rotations later on. Here are some goals I hope to achieve during the next 3 weeks:
1. Develop an efficient process to processing and verifying drug orders
2. Become familiar with preparation and distribution procedures for parenteral medications in the hospital setting
3. Appreciate the role of pharmacy technicians and the impact of their scope of practice in the hospital pharmacy dispensary
4. Become familiar with reporting medication incidents from the hospital pharmacy dispensary

Objectives to achieve these goals:
– Prepare and dispense 3 medications safely and accurately according to institutional policies and procedures
– Accurately transcribe 3 medication orders onto the medication profile of an inpatient
– Clarify 3 orders with physicians and other prescribers
– Demonstrate the safe preparation of 1 IV medication
– Name 3 logistical barriers to providing clinical pharmacy care when pertaining to drug distribution
– Name 3 unique roles that the hospital pharmacy technician assumes to expedite safe and effective drug distribution