Monday, April 28, 2014

Farewell and some quick APPE tips

As my final year in pharmacy school nears its end, I feel like it's time to say goodbye. This blog has seen me through a lot, from applications, to acceptance, and through many significant moments of my life. However, the timing feels right to close it now.

I'm happy, and very nervous to say I will be starting my PGY-1 residency this summer. Although it feels like something I've wanted and work so hard for these past four years, the prospect of it beginning soon terrifies me. I'm happy and sad at the same time that I'll be staying close to this place I've called home the past four years for one more.

I grew as a person and as a student these last four years. I remembered how much I love to learn and how much I enjoy being challenged. I never thought I would fall in love with acute care, but I haven't enjoyed anything as much as the insanity of an acutely change environment.

I actually didn't expect to fall in love either. Between classes, exams, leadership, and work I really had no time to devote to other aspects of my life aside from enjoying the friendships I made in school. After my ex-fiancé broke my heart my first year in school, I really didn't expect it to happen again so soon. But She changed my life at the most unexpected time.

We found each other when I needed someone the most, even though I didn't know it at the time. I was lucky to have her in my life. I regret that our relationship ended the way it did, but I can't help but feel so fortunate to have known her and loved her. I wish I told her I loved her, but it's too late for that now I suppose. I still think of her every day and I hope she's happy.

We may not be cheering for our hockey team together this year... and it's probably silly, but I'm glad every time our time wins or her baseball team wins because I know it at least made her smile. I still feel the loss and some days are harder than others. Some days I regret I let my anxiety and fear about change and uncertainty strain our relationship. I hope we win this year and I hope some day we find our way back to each other, even if it's just as friends.

I learned and grew so much through this blog and to those that rode along with me, thank you. It's been an amazing journey. Good luck to all of you on yours.

-- edit--

I figure I should at least end with some useful advice on APPEs.

To those of you who want the most out of your APPEs here is what I've learned:

1) Always ask "Why?" and dig deeper. Why did we start that medication? Is it appropriate? Is the dose, route, frequency, and/or duration correct or appropriate?

One of the biggest challenges for me was to remember to always question every thing. If I didn't catch any mistakes or improve patient care, I at the very least gained some valuable clinical experience.

2) Be as positive as possible about your rotation. Forget everything you may have heard. The mindset can very well be what holds you back the most or gives you the best experience you've ever had. Some days are hard, when you're tired, burnt out, and really just want to be done, but some days I took a step back and reminded myself that I'm here to learn and at the very least owe it to these patients to provide the best care possible.

I made some great interventions, but most of all I learned how to think more like a clinician and less like a student.

3) Do what you're comfortable doing. If you really want to do well, learn a lot, and especially gain the trust of your preceptor: know when you're not comfortable with something and let him/her know.
This is important for multiple reasons. If you don't understand or aren't comfortable doing something- research it and talk to your preceptor. They are there to guide you and help you think independently. This in turn helps your preceptor not only trust you more, but to gauge your abilities and feel more comfortable as time moves on to work more independently. Many of my preceptors hung back near the end and let me do my thing. Of course they checked every thing I did, but they were comfortable knowing I wouldn't make any decisions or talk to the team without talking to them first.

Learning to be autonomous is important and they are more willing to observe from a distance if you show them that you aren't likely to make dangerous errors, but they can count on you to not over step your boundaries. I know people that just guessed, but sounded confident. During rounds, this is especially dangerous. What if the team takes your incorrect advice? That's detrimental not only to patient care, but also with the relationship with your team.

4) Pick something new to learn, something you aren't familiar with and challenge yourself to learn it.
I always picked my areas of interest and I came up with lectures on topic discussions. This was a great way to improve my knowledge and teaching abilities.

and finally...

5) Trust yourself and know it's OK to be wrong when being pimped by preceptors, but take it in stride and say you'll look into it more and get back to them.
I can't tell you how many times I was too afraid to say an answer because I wasn't 100% sure it was correct. I hate being wrong and I hate feeling dumb, but you're there to learn. My best preceptors always asked me "why" after I answer their questions. Sure, it's annoying sometimes, but because of this they not only made sure I knew what I was talking about, but it made me challenge myself, too.