Dec 13, 2017
Joseph Muench, better known as "Pharmacy Joe" is a doctor of pharmacy and Board Certified Pharmacotherapy Specialist. He is the author of “A Pharmacist’s Guide to Inpatient Medical Emergencies,” host of The Elective Rotation: A Critical Care Pharmacy Podcast, and creator of an online Hospital Pharmacy Academy
Check him out at these links:
Welcome to the Pharmacy Leader's Podcast with your host Tony Guerra. The Pharmacy Leader's 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.
Hi, this is Pharmacy Joe of pharmacyjoe.com and you the hospital pharmacy academy and you're listening to the Pharmacy Leader's Podcast.
Welcome to the Pharmacy Leader's Podcast. Tonight I am with Pharmacy Joe, doctor of pharmacy and board certified pharmaceutical therapy specialist. He's author of a pharmacist guide to in-patient medical emergencies. He's the host of the elective rotation at critical care pharmacy podcast and creator of an online hospital pharmacy academy at pharmacyjoe.com. Joe welcome to the Pharmacy Leader's Podcast.
Thanks Tony, thanks so much for having me.
I always start off the same just so we can start with a baseline but you are a leading podcaster. The only podcast I know that has more lessons than or more episodes than you is the pharmacy podcast network at around 500. How did your leadership road end up here?
Well it's interesting. It was, I'd say a long road. I started off in community pharmacy and after a few years decided that I want to try something different. I switched to hospital pharmacy way back then about 2002 and practiced in hospital pharmacy, moved my way through staff pharmacist, all our satellite pharmacists, clinical pharmacist focusing on Med rack and then into a position about I would say six years ago focusing in critical care and eventually decided that I would start a website and a podcast as well.
So I was just ASHP and there are I don’t want to say people would kill for it but let's just say that a critical care position in a hospital where you're at would definitely be at the top of many people's lists. Just to start us off, what was and most people would think that things are just so easy for you now because you are critical care pharmacist; you are at the top of your license, everything's going great. What's maybe one of your worst moments?
I would say I really struggled at that transition point when I was going between staff and clinical pharmacist. I didn’t have a lot of direct training on how to move through those roles. I did not do a residency. I was at the same hospital moving from staff to clinical and I remember very clearly asking a provider to reorder a patient's ace inhibitor and he said to me, well what's the [indecipherable 00:03:03], what's the potassium, what's the blood pressure and, you know, it kind of hit me at that point like, wow now I'm up here on the floors I have access to all of the patients medical record and I'm expected now to incorporate all that into my decision making. And that was I'd say really the beginning of me doing some intentionally learning on exactly how I should be acting as a pharmacist in that role.
Yeah I think I just saw a survey, it was on twitter yesterday at i-form or something like that put it up there saying what do we call a pharmacist that has clinical training and about 60% agreed clinical pharmacist, number of people said just pharmacist and so how does someone make the transition not only in our mind but with the staff on the floor to say, oh, the clinical pharmacist is here I can ask them this level of questions versus maybe somebody that's more in a dispensing role?
I would say it really is first and foremost about that mindset. And it is something that is different than just your looking at an order at a single point in time in the pharmacy. You're taking the whole patient into account. You're doing what I call due diligence, researching not just the focus of your question but you're backing up a couple levels. Finding out who this patient is, why they're here and then you're taking all your knowledge to help whoever is asking you for advice to do the best thing possible for the patient.
So you take on fourth year APPE students. Tell me a little bit about how you transition them from learning to skill so while we're learning in pharmacy school grade, you know, we can pass the naplax or something like that but then something happens and we freeze because we don’t necessarily have the skill to solve that problem. How do you make that transition from learner to skilled practioner?
Well my students tend to get thrown right into the mix since there is an ICU that is where my primary practice point is in the hospital. We've got 19 beds, I've had many students have the story of I just finished orientation and I walked up to the ICU to meet Joe and somebody coded right when I was being shown the unit. So they do get thrown in there pretty quick and what I really focus on is I show them what it is that I'm doing and I try and kind of peel my head back and open it up and let them inside how it is that I'm thinking about things, how I think differently than I might think if I were learning the material for a test in college and that's where I start with them.
And then how does that, so we've got APPE students that are at various, you know, places, you know, whether you're in your first block or your ninth block it's maybe a different student but now once you get a resident, how do you start that process of getting a resident up to speed as where now are they going to rotate through PGY 1 is what you do with PGY 2s? How does a resident participate in a critical care process?
So at my side we have four PGY 1 residents that we take every year and I will often have a student on rotation at the same time so they will act as the co-preceptor technically but I really push them into acting as the full preceptor for the student as well. And I'm doing similar things with the resident that I may start out with the student but I expect them to grasp the concepts and accelerate the learning far beyond where an APPE student would and get them to a point where they can do ICU rounds, make sure that they are intervening when they should, participate in medical emergencies, code blue, rapid responses. You know it starts with showing them and then coaching them and then just being a safety net there to advise them.
So this knowledge that you have normally it would just stay within the hospital and then that would be it. You would go in, you would do your work and then you would go home, some residents would benefit some APPE students would benefit. But you have had now 250 podcast episodes where you've built this transfer of knowledge on these topics in critical care. First of all where did that podcast start and then maybe talk a little bit about the evolution in terms of how now you teach versus when you started?
Sure I did start the podcast with the intention of incorporating it into my teaching and what I really enjoy most about it is I can direct a student or a resident to a podcast episode and I can have them listen to that episode, follow the links that I have to the references and then when I meet up with them later we can discuss things at a much higher level. So not only am I able to facilitate transfer of knowledge and accelerate learning across the globe really with the reach in the website and the podcast. But when I have a student or a resident at a rotation with me I don’t have to say the same thing over and over and get stuck at a basic level of understanding. I can very quickly advance to a deeper level of understanding for those on rotation with me.
Now I have enough trouble keeping, I've only done 45 podcasts so far. I have enough trouble keeping track of those, dividing them into sections where I can easily get to them. How do you divide 250 podcast episodes into a library that's I guess usable?
Yeah it is quite a bit. I do have a structure to the podcast where every even numbered episode is going to be a topic that is a resource or job information question or a recent journal article and then the opposite numbered episode is going to be at this point a one minute or a one or two minute breakdown of one critical care pharmacy concept that I share. So I do kind of, you know, I record them all, I reference them a bunch of times. I am just kind of pulling them off the top of my head at most of the time when I am talking to them, the student about them or asking them to research something. I do have one of episodes, episode 100 where I have a four episodes that I have every student or resident listen to prior to coming on rotation from me and that includes my workflow a little bit about ICU rounds, preparing for ICU rounds and communicating with providers and other practitioners.
Ok yeah I ran into that too so I have an academic APPE so non-patient care but if a student comes in middle of the semester maybe they'll teach cardiology and endocrine but a student might ask about GI, so they still have to know GI and I'm finding that it is easier to give them, ok, well, here's my, for me it would be youtube videos, here's my two hours of youtube videos on the top 200 you have to know these before you get here. Otherwise you're going to lose all credibility if they ask you something that's related and you can't answer it. So it makes sense for the podcast but tell me a little bit about the book, now how is the book that you wrote, I know, some of it incorporates some of your podcast but what made you switch from, ok I'm giving these seven minute updates to a book? Because a book is a lot of work for someone that's already pretty busy.
Yeah absolutely so one of my passion is teaching pharmacist and students how to respond to in-patient medical emergencies, code blue or rapid response calls in the hospital when a patient's crashing and I like to show pharmacist how they can have a unique role there that's different than a nurse, different than a doctor and can really elevate the care that's given to the patient in that setting. So most of my early episodes on the podcast were essentially what I turned into chapters to the book. I expanded on them more, changed them into book format added up to more information but really the template was their because I was just doing really a stream of consciousness with the podcast about what I was interested in and then I look back and after a couple dozen episodes I have the template really for the book.
So is there another book coming or is that it for right now?
I have got so many titles that I'm thinking about doing. It's just at this point for me it's a matter of the time.
Yeah I know and I understand exactly where you are. I'm on chapter three at my book which I'd been on for, oh gosh, almost five months now so it's a little bit frustrating but again maybe we'll figure out some way to break through the, I don’t know what it is about that, maybe second book or third book where you've got this content. You want to develop it into that kind of next step and then it's just how do we find the time to do it. So, but you did find time to create, is it a video series or an audio series for the academy?
Yeah so when I started again based on feedback from folks that I connected with was a hospital pharmacy academy where I have really three things, I've got video based on trainings mostly on critical care at this point but I have just expanded to emergency medicine, general hospital pharmacy on infectious disease and the video based trainings really depending on the topic are anywhere from five to 60 minutes. It really depends how long it takes to get the scale across then I do a weekly literature digest for my members and I am summarizing the notable pharmacy literature that has been published in the past week. I look at about 24 sources of literature to come up with that summary. And then finally there's the forums where, these private members only forums, folks can connect with me there and they can ask me and other members questions that they have about practice in critical care or hospital pharmacy.
So as a nation pharmacy nation tends to be a little more on the introverted side. Besides you and helix talk I'm not familiar with many other pharmacy clinical podcast or sources of information that are audio, something that we could listen to. Why do you think that we that with 300,000 of us across the country, why do you think we're not hearing more from pharmacist that are in clinical settings?
That's a good question. I would put it down probably to imposter syndrome which is that voice on your shoulder that's telling you who are you to start a podcast, who are you to share your message with the other 300,000 pharmacist out there and I was lucky when I was thinking about starting the podcast I listened to a lot of folks talk about imposter syndrome and so much so that it's just something that I didn’t have to worry about because I had rationalized myself out of it. But I would bet that it's not the technology, the technology is relatively simple and but I bet it's the voice on someone's shoulder that's holding them back and the more pharmacist that ignore that I'd say the more role eventually have out there.
So tell me a little bit about what you're doing now with YouTube? YouTube is one of my favorite forums because I, a lot of the stuff we do fits into kind of that top 200 artist teaching pharmacy technicians and I also teach a lot of the pre-professions, pre-med, pre-nursing and so forth so. Those kind of lists work really well with YouTube but what do you do on your YouTube Thursdays.
On Thursdays I'm publishing simultaneously to my audio podcast feed and to my YouTube channel what I call the critical care pharmacy minute. So I will take one very brief and succinct topic and I will just cover it and my aim is to do it in under two minutes and push that out to people so that they can just have a real quick wind or a pearl that they get about whatever it is that I have on my mind at that time.
So where did this briefness come from? Did it come from working with other practitioners that need to know this information so quickly because the patients are critical or is it just something that you kind of just lashed on to? What is it that you like so much about these very brief updates?
So early on when folks were contacting me about the podcast and leaving reviews in iTunes that was one thing that really they appreciated. I didn’t have a intro at all really where I would ramble about anything. I got right to the point and I was succinct to the information and everybody was telling me that’s what they love most about the podcast. So I figured well if a minute's is good then let's try two or less and I got some great responses for that too so I kept with it.
Yeah I know YouTube has two searches that one is under four minutes and something is over I think 20 minutes or something like that but people search by under four minutes. So that's definitely under there but I wanted to take a little turn to kind of push your IT knowledge. I met with Tina Mowing from IBM Watson at ASHP, I don’t know her, I just met her and she's like, well I'm a pharmacist and I work with IBM Watson and that was a little bit of surprise to me because I just got my master of human computer interactions so I can speak a little bit to AI and just knowing what's going on with it. What can you tell me about technology or AI or things that you see coming down the pipe that maybe other people don’t know about already?
I'm most excited about using the mediums that we currently have to aid in that knowledge translation especially when there's new information that has been published and, you know, the typical length that people quote I think is somewhere from 10 to 15 years for that new critical information to be brought to the bedside. So I like the idea of using mediums that we have now like YouTube, like iTunes, twitter to get out that new information, start a conversation about it and I really liken it to, you know, we all have these conversations in the hallway, in the office, in the main pharmacy, with other pharmacist where we pick up good old tips and tricks but we're all connected now through all these mediums and I liken, you know, what we're doing on these platforms to just expanding the reach of these small conversations.
There was a book called rise of the robots and it was talking a little bit about how AI was coming to be and one of the stories in there was about cobalt poisoning from hip replacement and how the doctor actually solved the problem because they had seen an episode of house. But that would have been something that maybe, you know, big data would have picked up on. But I think more globally can you tell me a little bit more about the FOAM at movement I don’t, I see it come and go and I'm just not really in that group but I feel like that's kind of reserved for, is it reserved for emergency medicine or critical care, that’s where I tend to see it the most?
Yeah FOAM is the abbreviation given to free open access medical education so FOAM Ed doesn’t necessarily mean critical care but I will say it is a movement that was started primarily by critical care physicians and then has expanded so you can search the hash-tag FOAM Ed on twitter FOAM Rx, FOAM Cc, for pharmacy or critical care and you'll get some great content there. The general principle is people want their translation of knowledge to be free and open to everyone. And so that's the idea of having a podcast where you are just talking about information and there's no barrier for anyone else to listen.
So while our residents and APPE students kind of have a little bit of freedom in terms of that is their job as they're learning. Tell me a little bit about what it is that you do on a daily basis to keep your work on track? Obviously you've got this creative side and you've got a lot of production that way, how do you keep everything together? We share that we have both have around the same aged kids.
Yeah I've got two kids as well and those definitely are a lot to keep together. So I'm using maybe tools that I would consider fairly well known I've got Evernote where I'm keeping track of ITS for my next episodes, for resources I want to share, for drug information questions and on you saying a paper based journal, kind of a modified version of the bullet journal that I'm experimenting with right now. I don’t know if you're familiar with that where I am keeping track of not just everything I'm doing at work but everything I'm doing at pharmacyjoe.com as well. And just reviewing those everyday getting my most important tasks set up and just plug away the next day and then.
So going on to career normally I ask something like what's the best career advice you've ever given or received but in this case what I want to ask you is there's going to be about 50% that go into the match. Well that enroll in the program not go into the match it's a little skewed but look about half of them are not going to get what they originally expected. Can you tell me what you would tell that person who is expecting to be in a PGY-1 that next July?
Absolutely yeah, first I would try to go for the second round if they are able to do that and next I would have them think about is there any way that they can maybe broaden the location that they're willing to go to because certainly the narrower you are in your focus of where you are going to work. The fewer your options are but you could probably find an entry level position and get your foot in the door if you would just broaden, open the location that you're willing to travel to. Now that may not be possible some people have a mortgage already or a family and they can't do that if that's the case I would go for a PDM position. Anywhere you can just get your foot in the door in the hospital [indecipherable 00:23:07] hiring typically works as they're going to pull not from new applications, they're going to pull from internal people that they've already spent a little bit of training on. So if you're already trained as a PDM that means you're going to be next in line for the part time position and then you're going to be in next in line for the full time position. So anywhere you can get your foot in the door someplace even if it's PDM, that's what I would do.
Ok and then what inspires you?
So I am really inspired by other clinicians, other physicians, pharmacists, nurses that I see that are doing so much to care for patients and I am really just wanting to be like the other people around me and focusing on doing the best that I can for patient care.
Pharmacy Joe thanks for being on the Pharmacy Leader's Podcast and I would want to ask what's the best way for someone to contact you if they do want to talk to you?
Sure, I've got a bunch of ways that you can contact me. They all start out with Pharmacy Joe so whatever platform you're most comfortable on you can find me, pharmacyjoe.com/linkedin/twitter or /contact and head over to my website there and contact me right there.
Pharmacy Joe thanks for being on the Pharmacy Leader's Podcast.
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 Amazon.com in print, eBook and audio book.
So now that the show's over I'd like you to head over to pharmacyjoe.com/episode100 where you can get my critical care pharmacist workflow and the exact orientation that I use for my students and residents.
Thank you for listening to the Pharmacy Leader's Podcast with your host Tony Guerra. Be sure to share the show with hash-tag hash pharmacy leaders.