Adjusting to life on rotation

On Rotation Diary

Over the next year, I will be sharing my unique experiences while on rotation. To speak honestly and openly with you, I will write this column anonymously under the name “Brandon.” It is my hope to provide you with insights about rotations and the many pharmacy opportunities I encounter.

It is finally here. I have just completed my didactic pharmacy course work and I am eagerly starting my final year APPE rotations. Over the next six issues of Student Pharmacist, I will have the privilege of documenting my experiences and sharing with you my broad range of APPE rotations across the country. Many of my questions and concerns may be similar to yours as you embark on your rotations. I am fortunate enough to receive valuable feedback from other preceptors and this insight will hopefully answer some of the questions you may have about your own rotation.

In August, my emotions ran wild as I started my first rotation. I was extremely excited and utterly terrified!

New guy in town

After spending years in books, PowerPoints, and exams, I was finally ready to start applying my knowledge toward direct patient care, and what better way to do that than jumping into an ambulatory care rotation. This rotation brought me to the rural west with the Indian Health Service (IHS). I enjoy adventures, but before I even started my rotation, I had the challenge of finding a place to live, moving across the country, and not knowing a single person within hundreds of miles. Originally growing up in the suburbs of the Midwest and going to school on the east coast, the move was the first of my fears.

How am I going to handle life all alone in a new city on top of jumping into a challenging rotation? How can I be sure to not let the dramatic change and adjusting to a new environment effect my performance on rotation?

In over my head?

The clinic I rotated at serves the Shoshone-Bannock Tribes and the Northwestern Band of Shoshoni. Within the clinic are physicians’ offices, a dental office, and a tribal services section, which primarily serves women’s health issues and pediatric patients, and of course, an outpatient pharmacy.

In addition to filling and processing orders, the pharmacists run certified anticoagulation, hypertension, thyroid, and emergency contraception clinics through two private counseling rooms.

During my first week, the pharmacists told me that I would have more opportunities for patient counseling here than during any other rotation I would have. Along with the sheer quantity of counseling, they also mentioned a vast range of experiences, from difficult cultural and language barriers, to significant general and health illiteracy. Having little past experience in true patient counselling, I felt like I might be in over my head.

How could I have prepared myself to better communicate with patients? What should my goals be in regards to patient counselling during this rotation?

Confidence boost needed

Unfortunately, the years of classroom exams and PowerPoints don’t exactly translate to real practice. As I started diving into patient charts, medication information questions, and medication reviews alongside my preceptor, it felt like I forgot everything I learned. I know I have (or at least had) the knowledge to analyze labs and medications and disease states, but it’s as if being in a practice setting has frozen my response system to formulate an answer. I have been eagerly awaiting a chance to use my knowledge, but I seemed to lose my confidence when put on the spot.

What happened to the hours of studying I did the last few years? Is my preceptor judging my hesitance? How can I raise my confidence as a student on rotation when it comes to applying my knowledge?