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 Audible.com by midnight March 16th, 2018 they will earn a student registration travel stipend to provide to one of their members. Here's the link: https://www.audible.com/pd/Science-Technology/Memorizing-Pharmacology-Audiobook/B01FSR7HLE
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: https://youtu.be/OFBkCQ7Wmbg
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. We got a really fun episode. I've got Kevin Yee 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 going to 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 residency 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 20 minutes of it and then if you want to listen to the rest of it you can listen to it at Kevin Yee's YouTube channel. Just put in Kevin Yee pharmacy and you can hear the rest of that interview.
Lliterally nothing about you, 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, I think I did well on it. I decided pharmacy and compounding pharmacy so I pass a little bit at that.
Yeah I believe I did want 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 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.
First of all, like what made you want to do, 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 at a independent pharmacy before so I don't really know much about clinical pharmacy going into it. After my p-1 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 SSHP or Student Society of Health System Pharmacist which is kind of a local chapter of ASHP 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 it's for you? Like, I know you did a little shadowing but what's 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, an 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 the aspect being able to see everything about a patient and being able to make more clinical recommendations since you have their labs and have their allergies, you have some of their old medical history which you might not be able to have until pharmacy. So I really like that as well being able to use what I learned in school to help the patients that I'm serving.
I definitely feel that like more source of autonomy and like empowerment too, you know.
Because you have a lot more authority to do things. You're doing your PGY-1 right now, right?
Since there's a whole bunch of different type of residencies what type of residency are you doing right now?
So I'm doing what we call just a general practice PGY-1 or a post graduate year 1. So in a PGY-1 they have you experience a variety of different rotations. It 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 residencies like managed care or some there's some residency out there where you can specialize such as a PGY-1 specialized in pediatrics or PGY-1 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 is 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 done with your PGY-1, right?
Yeah I got seven months in now.
Yeah, so are you planning to do PGY-2 and all that as well?
So I actually decided to early commit to my program to do a solid organ transplant PGY-2. So next year I'll be one of the PGY-2 resident 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 PGY-1?
So my first expectation, so as a student 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 attending, 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 be intimidating but there's also a lot, they're still learning. So 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. I'll say, 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 attending on the floor trying to make recommendation to the attending I kind of just by passing go do the residency.
If I could do the 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 as well. And you also get to learn a lot from the attending when you have residents on you team.
Yeah sounds like going into a residency you're kind of scared about like making recommendations. You thought it'd be really scary.
And you wouldn't really have a voice but it's really cool to see that you actually did get to work on a team and develop those relationships too.
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 and 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 do 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 bypasses it but some of them are clinically relevant and so as the pharmacist you can look through their profile and see that there's an interaction between some of the meds that sometimes the doctors don't see right away or even recommend being allowed to 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 talking to the medical teams as a student you feel like you don't know anything. If you're 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 little you actually know.
Especially trying to incorporate what you learned in school because what you learn in school doesn't always apply to real world.
Can 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 five 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 so amayocin, 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 MRFC infection. We can't just send them home on a line, you know.
Patients don’t really like that. They used to think of other alternatives like lenezolid or something cheo that can be taken. So making recommendations like that or sometimes medications could be resistant and so, you know, a doctor might put them on whatever the first line drug use empirically. But of course when cultures come back and you see resistance you can recommend changing to an 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 and third line agents, they're like, ehh like, those aren't important.
In real world sometimes you do have to use those or especially I think a big thing is drug allergies.
Yeah, yeah, yeah.
So, you know patient's like the, yeah like patient might 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 patient 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.
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 in my skills and that's actually one reason why I went into residency is trying to become more confident.
Oh that's interesting.
Yeah gain that knowledge because I felt like if I went straight into work something bad was going to happen to my patients because I didn’t know what I was doing.
So I really wanted to be kind of, do you know residents nights because you're kind of an in-between so you're independent because you have your license, 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 and potassium because I was so afraid to verify orders because I didn't know what to look for I was scared if I verified order that something would happen to my patient, that would be my worst fear.
And so now I verify much more things than potassium and magnesium.
I hope you do.
Yeah going through 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 in 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 too. Because at the end of each rotation we do kind of a sign-off where we talk to our preceptor, see what our strengths are in that rotation and what we can work on the rest of the year. So it's nice to hear from your preceptors when they compare you to day one to the end of the rotation. How much you've improved or how much more, you know, now and how confident they are in your abilities to dose certain medication. So I think I've gained a lot more consonants now and I remember one of my preceptors 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, does it sound okay. And after a while he was like stop asking me attend your rounds. Because you've been asking for three weeks and you're a resident you should know.
Being able to do this, so anything after that I'm so much more confident now calling doctors and not being afraid 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 bankamice and that was dosed very incorrectly for chemo dialysis. So chemo dialysis 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 the 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 license another thing I think of is you can also lose your license if something happens if you verify an order and it's incorrect, so.
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 its right I think it's very important to stand out for your decision to give background information and to really push your stance if you think it's a patient safety issue.
Well that was 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.
I think once you get experience I mean wherever you work out whether it is retail or hospital independence you're going to feel inadequate when you first start working as a new grad. Some people well, not everybody.
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.
Yeah it's different having your name on that medication order compared to having the pharmacist that you were working for under before.
Because now you're licensed.
Yeah I think it gets more scary in retail because you have to really check what your technicians are doing. 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 retails, 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.
So that's number two, confidence. What's number three?
Number three, I think 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. You're trying to balance being well-rounded whether 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.
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 only 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 or 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 at residency in 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. 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 is 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 all of those things are important but you also need to take care of yourself.
So like how 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 are due. I have a daily schedule that I do depending on the rotation and so I either work on patients 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 incorporates 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 too by my importance, all my hard deadlines and more important deadlines are in red, things for 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 you, I know you have a daily thing but do you like, look at goals and timelines 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'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 too.
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 residency related?
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 or 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.
Can 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.
So I come in depending on how many patients you have. So I'll 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 meet with your preceptor 30 minutes before so maybe 7:30 and then you'll round with your team at 8 o'clock to 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 in the afternoon is really more of following up on your intervention seeing if those are followed through or anything else you 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 the time commitment for like pursuing the residency and stuff. Let's see, were at number three, what's number four? What's your fourth expectation?
Alight well, that was Kevin Yee 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 20-25 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 don’t cross at the meeting or 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 most 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 going to 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 going to 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 and 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 Audible.com reviews and it has to be a review of the audio book it doesn't count if it's an amazon.com 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 audible.com. 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 two APHA ASP chapters that get to 25 reviews of memorizingpharmacology.com on audible.com 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 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 winners Karlie, Casey, 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 residencies and all those things. The biggest problem you're going to run into is being ignored and not being noticed and as 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 of 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 we'll be from Nashville.
Support for this episode comes from the audiobook Memorizing Pharmacology. A relaxed approach with over 9,000 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 amazon.com in print eBook and audio book. Thank you for listening to the Pharmacy Leaders Podcast with your host Tony Guerra. Be sure to share the show with the hash tag hash pharmacy leaders.