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Pharmacy Leaders Podcast: Inspiring Leadership Interviews

Feb 14, 2018

At the end of this episode, I announce the four winners of the Student Registration Travel Stipend contest and we kick off another contest! If up to two APhA-ASP Chapters can provide 25 reviews of the Memorizing Pharmacology: A Relaxed Approach Audiobook on by midnight March 16th, 2018 they will earn a student registration travel stipend to provide to one of their members. Here's the link:

On this episode of the Pharmacy Leaders Podcast, Kevin Yee interviews Janice Burgos, PharmD and current pharmacy resident and does a five question Reality vs Expectations episode that I know you'll find valuable. I have the first three questions on my podcast and you can see the full episode here:

Full Transcript:

welcome to the pharmacy leaders podcast
with your host Tony Guerra the pharmacy
leaders podcast is a member of the
pharmacy podcast network with interviews
and advice on building your professional
network brand and a purposeful second
income from students residents and
innovative professionals
welcome to the pharmacy leaders podcast
got a really fun episode I've got Kevin
Yi who is a youtuber and I asked if I
could borrow some of his audio for this
episode he's interviewing a resident and
doing the reality versus expectations
and for those of you that don't know
what that is you take five questions and
it's what you thought something was
gonna be and then you end up with
something different and she goes and
answers the questions and says you know
this is what I thought residents he
would be like and these are some of the
surprises that she had so after that
interview I will announce the four
winners of the APHA travel stipend
contest and hope you enjoy this episode
I've only got the first twenty minutes
of it and then if you want to listen to
the rest of it you can listen to it at
Kevin Yi's YouTube channel just put in
Kevin Yi pharmacy and you can hear the
rest of that interview literally nothing
about me I just like slid in your DMS
and just asked you to do this interview
on the fly so I think yeah so do you
know what reality versus expectations is
by the way I did a couple your videos
pharmacy and compounding pharmacy so
class a little bit at that yeah I
believe I did one on like informatics
and a whole bunch of different things
but basically for y'all that don't know
what reality versus expectations is all
it is is basically five things that she
thought that her pharmacy residency
would be like and what actually happened
so it can give you a better gauge of
whether you want to pursue residency or
not and what not so and dispel a lot of
the rumors and whatnot so I think it'll
be really fun yeah first of all like
maybe you want to do let's let's go back
let's go into like the reasons why you
did residency and all your like history
and stuff so what made you want to even
do residency so I have a lot of
experience in retail I worked also an
independent pharmacy before so I don't
really know much about clinical pharmacy
going into it after my p1 year they gave
me an opportunity as a student to do an
observer ship program so basically I was
at a local hospital for six weeks and I
got to shadow pharmacist both in the
central pharmacy area where they filled
the medicines for the patients and
another five weeks of shadowing various
clinical pharmacists and different roles
such as infectious disease cardiology
transplant and then after seeing that
interaction and just their dynamic with
the medical team and the interventions
they were able to make I started
becoming really interested in clinical
pharmacy and becoming or going through a
residency to get that position and then
I became really involved with s SHP or
student Society of Health System
pharmacist which is kind of a local
chapter of a SHP which is the American
Society of Health System pharmacists and
through there I was able to talk to
different practitioners who were working
as clinical pharmacists and seeing
whether or not it was something that I
thought I would want to go into how did
he know is for you like I know you did a
little shadowing but what was that
experience like actually finding
something that you actually were
interested in
yeah so before that I guess I only
thought I could be either a retail
pharmacist where I worked before
independent pharmacist or working in the
hospital just filling meds I didn't
really know that pharmacist could be
part of a rounding service and working
with physicians and I'm the type of
person based on my personality I really
like talking to people face-to-face and
doctors face-to-face which is what I
missed in retail because you call them
and then you'll make a recommendation
they're like who are you and why are you
even making this recommendation in the
first place whereas in hospital pharmacy
I noticed you work much closer with the
physicians and I really liked that I
also like to aspect being able to see
everything about a patient and being
able to make more clinical
recommendations don't you have their
labs and have their allergies you have
some of their old medical history which
you might not be able to have you tell
pharmacy so I really like that as well
being able to use what I learned in
school to
I definitely feel that like more source
of autonomy and a like empowerment - you
know because you have a lot more
authority to do things you're doing your
PG y1 right now right mm-hmm yeah since
there's a whole bunch of different types
of residency's what type of residency
are you doing right now so I'm doing
what we call just a general practice PCI
water postgraduate here once though in a
PGI one they have you experience a
variety of different rotations you could
depend on the hospital so I work at a
hospital that's very icy and cardiology
focus and so those are two of our core
rotations we have to do and of course
you have infectious disease internal
medicine so it's kind of getting a
little bit of everything
I know there's other types of
residency's like managed care or some
there's some residency out there where
you can specialize such as a PG y one
specialize in Pediatrics or PG a one
specialized in ambulatory care where you
have more rotations that are geared
toward those specialties but the one I'm
in right now which is probably the most
common one out there it's just a general
practice so you can see a little bit of
everything and see what you really like
and now that you're coming well you're
almost you're almost done with your PG y
one right yeah I got seven months in now
yeah so are you planning to do PG y -
and all that as well mm-hmm so I
actually decided to early commit to my
program to do a solid organ transplant
pgy - so next year I'll be one of the PG
y to residents in solid organ transplant
dude that's awesome
so let's jump into it let's do the
reality versus expectations as planned
like I said earlier we're going to do
five different things that Janice
actually expected and what really
happened so Janice what was your first
thing your first expectation going into
a PG y one so my first expectation so as
a student you you rotate and you have
some experience with your Appy's on the
hospital pharmacy and so as a student I
remember being so intimidated by the
medical team by the attention by the
medical residents and always talking to
my preceptor and asking them questions
because I was so scared to just make any
interventions and so I thought it would
be very similar coming into residency
and it was at first because you sought
to build that rapport with the team but
I realized it is actually much easier to
talk to medical residents than it seems
because they are doctors so it can't be
intimidating but there's also a lot
there's they're still learning
they're learning just like you are
because they're residents and there's a
lot of things that they don't know that
as a pharmacist or as a pharmacy
resident you can help them with and so
I've been able to make really good
relationships actually with all the
medical residents that I've been on
service with and so I have all their
phone numbers and I tell them they can
always text me so text me if they have a
question about a patient or if I have
something that I want to intervene on
it's much easier to tell the medical
residents that I'm trying to find the
attending on the floor trying to make
recommendation to the attending I kind
of just by passing go do the residents
yeah if I could get intervention that
way and I've actually become friends
with a couple of them as well which I
didn't really expect going into
residency and it's much easier to talk
to them and it's really nice with the
medical residents when you have a team
because the attendings tend to teach as
well so whatever they're teaching the
medical residents you kind of get to
listen in on me as well and you also get
to learn a lot from the attending when
you have residents on you team yeah
sounds like going it like going into a
residency you're kind of scared about
like making recommendations you thought
be really scary and yeah you wouldn't
really have a voice but it's really cool
to see that you actually get to work on
a team and develop those relationships -
yeah what kind of like as a pharmacist
like as a clinical pharmacist what kind
of things you find yourself helping the
residents with most so of course medical
residents they think very whole picture
body so they're trying to see what's
wrong with the patient what are their
problems that how can we fix them so
sometimes they're not as focused on some
of the medications so they'll put them
on the right medication but it might not
be the right frequency or dose which is
commonly seen actually with antibiotics
though they'll say okay this patient
will need this antibiotic for this
infection and at this dose but they
don't always look at their crap main
function if we need to adjust the dose
at us probably the most common
intervention that I view is adjusting a
dose for a patient you see the renal
function or their age or they don't
always look at strong interactions
either so you know they have that click
fatigue so you have all these alerts
come up on the electronic medical record
everybody just bypass to it but some of
them are clinically relevant and so as
the pharmacist you can look you know for
a fall and see that there's an
interaction between some of the meds
that sometimes the doctors don't see
right away or even
the a lob be taken for a patient for
example TTC prolongation which you can
see you know with like amiodarone and
levaquin sometimes you know there hasn't
been a level for like a month so you
probably should get one to see if we
need to change therapy so those are kind
of the most common recommendations that
I make what was your second thing by the
way my second thing is confidence it's
aligned with being intimidated on
kinematical teams that the student Euler
you feel like you don't know anything if
you as a resident you feel like you
don't know anything especially coming
out of pharmacy school someone told me
that when you're graduating pharmacy
school that's when you think you know
the most and then when you start working
you realize how low you actually know
yeah especially trying to incorporate
what you learned in school because what
you learn in school doesn't always apply
to real world you give an example about
that like something every day that you
experience yeah so one example for
example you know we have our first fight
agents that can be used or you're like
okay I should always use like let me see
so trying to think of a clinically
relevant example short mr.singh you know
let's use vancomycin you know for those
infections but things that you don't
think about is okay we want to send the
patient home now but he still have an
MRI see infection we can't just send
them home on a line other alternatives
like when a salad or something Pio that
can be taken so making recommendations
like that or sometimes medications could
be resistant and so you know a doctor
might put them or whatever the first
line drug use empirically but of course
when cultures come back and you see
resistance you can recommend changing
too and I put more appropriate agent
which is kind of you know in school
you're kind of used to spitting out what
you remember what the first line agents
are you like oh they're second if
they're light agents but you like it
like those aren't important yeah real
world sometimes you do have to use those
or especially I think a big thing is
drug allergies yeah yeah like patient
I'd be allergic to penicillin or
allergic to cephalosporin so you might
not be able to use the first-line agents
and think of you know
some weird alternatives for that
patients if they can't use it so those
are kind of like the most common I can
think of that you kind of have to be a
little bit more creative yeah and not
just go by what the textbook says or go
by what you learned in school per se
and so yeah confidence so going to a
residency I felt very unconfident and my
skills that's actually one reason why I
went into it I didn't think is trying to
feel more confident oh that's
yeah gain that knowledge because I felt
like if I went straight into work
something bad was gonna happen
because you're kind of an in-between so
you're independent because you have your
life scenes you can verify orders you're
a pharmacist but you still have a
preceptor so in a way you're almost like
a student because you can still run
things by somebody and ask them for
recommendations and some help so that's
really nice I think and one of the
reasons I also considered going into
residency and so confident so it's nice
looking back like six or seven months
ago when I first started I remember
staffing for the first time in the
hospital pharmacy and only verifying
like magnesium potassium I didn't know
what to look for I was scared if I
verified order there's something would
happen to my patient that would be my
worst fear yeah so I now I verify much
more things than potassium magnesium I
hope and especially rotations help a lot
because I've had my ICU rotation already
I've had infectious disease I've had
anticoagulation so I've just gained so
much more knowledge now and I'm so much
more confident and what to look for what
interactions to really know what labs I
should look at when verifying meds so I
feel like I'm more confident and just
hearing feedback from my preceptors
helps a lot to you because I can end of
each rotation we do kind of a sign-off
where we talk to a preceptor see what
our strengths are in that rotation what
we can work on the rest of the year
so it's nice to hear from your preceptor
is when they compare you to day one to
the end of the rotation how much you've
improved or how much or you know now and
how confident they are in your abilities
you know so certain medication so I
think I've gained a lot more consonants
now and I remember one of my three
sisters told me even during rotation
that I need to work on confidence
because I know what I'm doing I'm just
not confident enough to bring it to the
team so I would always still ask my
preceptor hey I want to make this
recommendation doesn't sound okay and
after a while he was like stop just
because you've been asking for three
weeks and you're a resident you should
know yeah being able to do this though
anything after that I'm so much more
confident now calling doctors and not
being afraid to to defend my stance
because some doctors or some residents
may not agree with what you want to
recommend for your patient even though
you think it's what's best and maybe
it's not right because they know the
patient more than you do since you're
kind of just looking at notes you don't
see the whole patient every day but
sometimes as a pharmacist for example
one time I was working and there was a
patient on Bankim ice and that was dosed
very incorrectly freaking more dialysis
so hemodialysis they should be dosed on
Monday Wednesday Fridays or whatever
days they get chemo dialysis after that
day so it's not like an everyday dose
and this patient was on everyday dosing
and so I called a physician and I called
a resident and he just did not want to
discontinue to order he said it's fine I
think it's correct and so you know it's
easy to just back them like oh the
doctor says it's okay the doctor says
that but you also want to care for your
patients and think about your patients
first and so you know I knew that this
dose isn't right and that there could be
some consequences for the patient so I
just kept pushing gave him some
literature some evidence of why we
should change the dose and eventually he
agreed to change the dose as well so
things like that I don't imagine myself
doing seven months ago but now that I've
been experienced and I really take an
ownership of my licence kinder than you
think of is you can also lose your
license if something happens if you
verify an order and it's incorrect yeah
you really want to take that
responsibility and care for your patient
so even if a doctor doesn't agree with
you but if you think it's right I think
it's very important to stand a food
decision to give background information
and to really push your stance if you
think it's a patient safety issue well
that's a lot I was going to ask you like
what are the best ways like as the new
resident like what's the best way to
build confidence but you said a lot of
different things you said getting honest
feedback from your piece up there
trusting in yourself and knowing like
when to pick your battles and if you
have to like send literatures send
evidence and stuff too and I think
experience too is a big thing yeah once
you get experience I mean wherever you
work out whether it is retail or
Hospital independence you're gonna feel
inadequate when you first start working
as an abroad no it's a no I hundred
percent agree with that I remember like
my first days like practicing community
and I was just like I was like huge mass
like even though I've worked community
pretty much like for a really long time
like it was really different being a
pharmacist yes
different having your name on that
medication order compared to having the
pharmacist that you were working for
under before because not your license
yeah because you have to really check
what your technicians are doing mm-hmm
and because you can't always trust you
know what they typed in or what they put
in the bottle so you have to be very
careful I remember when working retail I
was you know looking up to my pharmacist
and how detail-oriented they were yeah
and it's like I think a lot of like
especially with community I feel like
it's more of the soft skills that really
pushed you forward because as you get to
work with someone you get to know their
strengths and weaknesses just like how
your preceptor kind of assessed you but
there's certain things where you know
that you know they're more little error
prone so you just try to catch on to
that a little better you know yeah so
that's number two confidence what's
number three number taste any time
management you hear that in school and
you think in school you're able to
manage time going you know from
undergrad to pharmacy school and you're
trying to balance being well-rounded
where that be leadership or community
service but still trying to make decent
grades to pass pharmacy school or
anything else that you're involved in
outside of school coming out especially
me I thought I had pretty good time
management skills yeah you know I keep a
calendar I keep a planner I'm on top of
my deadlines but residency really is a
different world with time management
skills because not all
do you have you know your patience to
work up meetings with your preceptor but
you also have research projects you have
to work on sometimes you have to teach
lectures for certain colleges a pharmacy
or you have to help like for us right
now we're help with interview sessions
and so you really have to be on top of
your deadlines we do a lot of
presentations that's some of the
clinical meetings that we have to
prepare for and then you can also be
flexible I think because like random
things happen and you just have to roll
with it for example if a code happens
you know you could drop everything that
you're doing go to that code or you
might have your preceptor or the manager
ask you if you can pick something up and
so you'll have to work on that on top of
everything else that you have planned so
I think time management is very it's a
very needed skill and residency and
making sure you're on top of all your
deadlines because it's not like pharmacy
school you have a syllabus and they're
like okay you know these are your exams
and you kind of study every so often to
get ready for your final mm-hmm in
residency depending on the program
they'll just tell you okay it's due at
this time so you have to make your own
timeline of when to work on these things
in order to finish everything by
deadline and it could be harder for some
people compared to other people
depending on what your experiences are
and how you manage your time in pharmacy
school what you're involved with before
but I think you know time management
very hard especially also trying to
balance work in home life trying to
balance you know still spending time
with friends and still doing the things
that are important to you whether that
be community service or going to the gym
or anything else you're involved with I
think those are also things you have to
consider when doing time management
because nothing is important but you
also need to take care of yourself so
like how do often do you look at your
schedule or how do you balance
everything out then yeah so I have so
our program itself actually gives us a
calendar of all our deadlines for the
year and when kind of the major projects
I do I have a daily schedule that I do
depending on the rotation and so I work
up patience and then I have a schedule
for rounds and meetings for that
rotation and then I also have my
personal planner where I write down kind
of all the things going on in my life
that I have to do and then I have my
Google Calendar which kind of
like my work email
calendar and also some personal stuffs I
have a lot of calendars and then I have
I kind of color code my calendar to buy
importance all my hard deadlines and
more important deadlines are in red
things her family are in another color
and then other assignments for work I
have in another color to help kind of
balance those things out and how often
do I know you have a daily thing you
like look at goals and timelines that on
a weekly basis monthly basis as well or
like yeah
so I usually look every Sunday or every
Saturday kind of to see what's happening
the week ahead what things I need to
prepare for whether it be topic
discussions or a presentation I have to
give I give I'll give those a look and
at the beginning of every month I look
also to see what's coming up for that
month whether it be a hard deadline for
research project or things that we might
need to submit for some of our clinical
meetings and look at those - oh cool I
know every single residency is different
but what's a rough estimate of how much
time you spend on residency yeah so but
like either at work or doing stuff
residents you really did yeah yeah like
what is the sense of time commitment you
know for a residency yeah so on average
people would probably say on average in
general residency you work about 60 to
80 hours a week so whether that be
physically at work we're doing stuff at
home for me in a day I'm usually at work
depending on rotation of course and how
early you have to round I would say like
seven to five or six thirty to five so
that's about what like 10 hours 11 hours
a day that I'm here at work and
sometimes I'm at home you know reading
as well reading for articles or for
topic discussions so I would say
probably I'll spend 12 to 13 hours a day
doing like residency related stuff and
then on the weekends I staff I work a
little bit more those weeks as well and
then we also at my program we do evening
shifts and so we work until like 10:00
p.m. on those days so those days are
like 16 or 17 hours long do you take me
through a typical day for like a
residency so usually in the morning you
come in work up patients so let's just
say theoretically around that 8 o clock
yeah um so I come in depending on how
many patients you have all come in maybe
6:30 or 7 o'clock to look at my patients
work them up get ready for rounds
maybe in the beginning of residency you
might be but your preceptor 30 minutes
before so maybe 7:30 and then you'll
round with your team at 8 o'clock -
let's say lunch time around 11:30 around
and then sometimes during the lunch
meetings you'll have presentations
either given by students given by other
residents or other meetings you have to
attend so that might be until 1:00 1:30
and an afternoon is really more of
following up on your intervention seeing
if those are followed through or
anything else need to check up on or
follow up on from Rounds topic
discussions with your preceptors
meetings with your residency director or
working on your projects is mainly in
the afternoon yeah that definitely gives
a better sense of like time commitment
for like pursuing a residency in South
let's see where are number three what's
number four what's your fourth
expectation right well that was Kevin Yi
and hopefully you'll go over to his
YouTube channel and listen to the rest
of that interview but we try to keep him
to 2025 minutes for your commute just a
quick announcement regarding the winners
of the contest so most Facebook Likes
congratulations to Carly Roberts
University of Louisiana Monroe for the a
review of pharmacy leaders podcast
episode that goes to Casey Rathburn the
University of Houston and for the review
of memorizing pharmacology a relaxed
approach the audio book that goes to
Eric Simpson and I believe he's from
university of the sciences he's got on
his Facebook he's got all kinds of
Philly stuff on so I'm assuming that's
where he's from
seems pretty clear and we have a problem
though so there was another outstanding
person who got I think a ton of Facebook
Likes has clearly been a leader at his
own chapter and so I just needed to add
this fourth stipend so Anthony De
Angelis the third of the University of
Rhode Island congratulations as well so
the four of you just get in touch with
me I'll be at the meeting if we
cross at the meeting where I can just
hand you the check we can I can get your
address or whatever and give it to you
after but you just the only thing you
have to do now is just make sure that
you go to the meeting I thought it would
be fun to do one more contest so we have
a month left before the meeting starts
and I don't know if a chapter can put
this together but I talked to somebody
and said you know what would be really
cool and what I guess I care about the
is making sure that other people
understand their medicines and that
memorizing pharmacology a relaxed
approach book really came about because
when I went in to teach pharmacology
class I would always hear you're not
gonna fail me are you and it's very
tough when someone is scared of
something that they're going to learn
about it so think about your patients
being scared of something and how much
can they learn if they're scared of the
medicine you know that's gonna be a
skill that we need so here's the
challenge this is a challenge for the
APHA ASP chapters and what I'll do is if
this does work out then there's two of
them I'll hand the check to the
communications or the VP of
communications at that VP of
communications meeting that I think is
on Sunday I'll try to find you and you
can give it to whomever you would like
at your APHA ASP chapter if you already
won that's fine and you've got somebody
else in the chapter any of those four
who are the leaders in those chapters
can do it as well but here's the
challenge very simple just like Eric
Simpson did just like Casey Rathburn did
on the memorizing pharmacology reviews and it has to be a
review of the audiobook it doesn't count
if it's an review and if you
can get 25 reviews and it doesn't have
to be chapter members it just the award
goes to the chapter it's just 25 people
that in some way probably need to learn
about drug names and the book is free if
they've never been to so I'm
not trying to get people to buy a book
and I know the math doesn't work out for
that so the challenge is this
first to APHA ASP chapters that get to
25 reviews of memorizing pharmacology
comm on I'll be happy to
hand each of you travel stipend check
for the registration of 278 bucks again
I don't know if it can happen I don't
know if that's something that you would
be able to rent nest muster the troops
to do but I just think it would be
interesting and it would certainly be
valuable to me the most valuable thing I
can get is feedback and the most
valuable thing for any author on audible
are reviews of their work so again
congratulations to the winner karlie
Eric and Anthony and I hope you guys
take me up on this challenge and I'm
hoping to give out two more checks at
APHA and I'll give them to the VP of
communications because I think the most
important thing that I can give you as
someone who's been in practice for
almost 21 years is that the biggest
problem you're going to run into isn't
going to be the job market and the
residency's and all those things the
biggest problem you're going to run into
is being ignored and not being noticed
and has a profession the most important
thing that we can do is make sure that
the things that we're doing are getting
noticed and those fall under the
Communications VPS getting the word out
there just like I know the University of
Houston had this viral campaign that
just was absolutely phenomenal
so those are the types of things that
I'm hoping an APHA ASP chapter will do
and I think that if you can get 25
people to put a review up then I think
that you've done a pretty good job of
showing that you can do those kinds of
things so good luck to everybody
congratulations everybody and next time
I'll be speaking to you directly will be
from Nashville support for this episode
comes from the audio book
memorizing pharmacology a relaxed
approach with over 9000 sales in the
United States United Kingdom and
Australia it's the go-to resource to
ease the pharmacology challenge
available on audible iTunes and in print ebook and audiobook
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