Narrator - Dr. Abel 00:00 Welcome to HelixTalk, an educational podcast for healthcare students and providers, covering real life clinical pearls, professional pharmacy topics and drug therapy discussions. Narrator - ? 00:11 This podcast is provided by pharmacists and faculty members at Rosalind Franklin University, College of Pharmacy. Narrator - Dr. Abel 00:17 This podcast contains general information for educational purposes only. This is not professional advice, and should not be used in lieu of obtaining advice from a qualified health care provider. Narrator - ? 00:27 And now on to the show. Dr. Sean Kane 00:31 Welcome to HelixTalk. Episode 81 I'm your co host, Dr. Kane, and I'm Dr. Patel, and unfortunately, we don't have Dr. Schuman today, but he's with us in spirit. Speaker 1 00:39 And that being said, we are going to today talk about how to survive on APPE rotation. So the title of our episode is top eight ways to excel in your APPE rotations. And we figured this will be a good start, because most students are just embarking on their APPE journey, absolutely. Dr. Sean Kane 00:56 So we've kind of split this up into eight different sections in terms of tips, tricks, things to think about in order for you, as an APPE student or a future APPE student, to be as successful as possible on that APPE rotation. Speaker 1 01:09 Some of these things are, I don't know, intuitive. You know, you've kind of learned that through your IPPE rotations and stuff like that. But this is more geared towards APPE so things may be redundant. Things may be part of your actual evaluation. So kind of gearing up and understanding the underlying concepts of that, you know, you're always kind of being graded throughout your rotation. And so every single component, the way you behave, the way you approach task and patient care and stuff, everything counts towards your APPE success. Dr. Sean Kane 01:43 And Dr, Patel, even though you said that many of these are intuitive, I've come to find out in the several years of precepting students that as intuitive as you think something might be, there's always that one student that really makes you question, how intuitive must it be? And I think the first one really speaks to that in its professionalism, intuitively, I would assume everyone knows that you should be professional, but sometimes that's not always the case. So in your experience, at least, what are some of the professionalism things that you see, and what are some tips to be as professional as possible? Speaker 1 02:14 Well, I think the first and foremost thing when I sometimes encounter students on the first day and I tell them, Hey, meet me at this location. And then they stroll in, like, five minutes late and tell me, Oh, I never received this email. And it's not up to the preceptor to reach out to you. It's actually up to the student to reach out to the Preceptor asking about, you know, rotation site. What are the logistics? Where do I park? Where do I want to meet with the preceptor on the first day. You know, just in case you're getting lost or running late, how do I contact? Who do I contact, and if there are any special requirements for the attire? I mean, you can't imagine walking into a nuclear pharmacy rotation with your makeup and hair done and, you know, nail polish on, because they would want all those things removed before you walk into a sterile environment. Dr. Sean Kane 03:03 Yeah, and I just want to echo that email that's really your first impression, your email to your future preceptor for your APPE rotation, you should be sending that one to two weeks in advance of that rotation, asking all these questions for the preceptors out there, at least for me, I love having basically a handbook, or at least an email template of all the stuff that they're going to ask me, so that I never have to recreate that every time. And also it means that I make sure I have every component every single time in the email of what my expectations are for that student. Speaker 1 03:35 Absolutely, I think it's a good idea to save some time and to just change things as necessary as to, like, you know, where do we want to meet in case there is a construction or something? But it also, it's important to ask about the type of rotation it is, and what do you need to as a student prepare ahead of time. So things that need to be reviewed, topics that need to be brushed upon before entering the rotation. I think it's a great deal, because, you know, when you are in the first rotation, yeah, baby steps are given to you. But when you're on your third or fifth rotation, they expect you to start swimming starting your first day. So having a head start is very important. Dr. Sean Kane 04:11 That's an argument to actually send that email out a little bit earlier, so two weeks in advance, to give you a little bit more study time to prepare the topics that you need to prepare Exactly. Speaker 1 04:21 And I think in the world of technology, another professionalism related thing is to using your cell phone. You know, nowadays there are tons of resources available. There are phone and mobile applications out there. So very well. To your defense, it might be that case that you're looking up a drug information on your phone, but it still may come across as unprofessional that you're kind of just looking over your phone while there is a rounds going on. So it's always a good idea to talk to your preceptor at the beginning of the rotation that, Hey, I didn't bring my tablet today, or I didn't bring my laptop today, but I'd be looking at my phone for drug information pertaining things. Dr. Sean Kane 05:00 And I would say that on rounds, at least where I practice on the inpatient setting, it's almost impossible to not be professional with a phone in your hand. On rounds, even if you're looking up a drug information request, it is so so much of a red flag to see phone out. On rotations, you assume that the student is checking out, as opposed to checking into something on their phone. So if you can avoid it, I would really advise you to just not take out the phone on rounds at all. Of course, you can pull it out after rounds when you're discussing with your preceptor and stuff like that, but on rounds, you really should have your attention as focused as possible and minimize the time that you're pulling out that phone. Right? Speaker 1 05:37 You can always, you know, have a notepad or a book with the clipboard and write things down that you need to look up, you know, before you discuss the patient with the preceptor, that way, you then remember that you need to look those things up if possible. You know, get a computer access, or bring your own tablet where you can access the intranet of the organization, so you can access the internal library and the resources there, it looks a little bit more professional that you're doing so on a laptop versus looking at your phone Dr. Sean Kane 06:07 and kind of piggybacking on professionalism. Our number two thing to talk about is punctuality, which clearly has a professionalism ring to it, but it's so important we give it its own item, because it's such a common professionalism issue with students. Speaker 1 06:21 Yeah, and I think in general, I mean, you want to be punctual on every single day of your rotation, but it's very important to do on the very first day to arrive at least 15 minutes early. Give yourself a 20-15 minute buffer. Just in case you never thought how big the parking lot is, or that you have to park in the furthest location out there. It may take you a little while to walk to the location where you are meeting your preceptor or where the pharmacy is located. Dr. Sean Kane 06:48 And of course, if you're taking public transportation, so in the Chicago area, if you're taking the CTA, for example, you never know what's going to happen, and it's always in your best interest. Even though it's less convenient, it's in your best interest to add a little extra time, 15-20 minutes of buffer time, just to make sure that you're not late, because again, that first impression is really important, and during that rotation, whether it's a four or six week rotation, if you become late on multiple occasions, that becomes such a huge red flag and such an easy professionalism issue to harp On as a preceptor, just don't make it an issue. Be there early, consistently early. If lateness becomes an issue, it's going to be a big issue when it comes down to your midpoint evaluation and your final evaluation, right? Speaker 1 07:32 So again, kind of going along with the punctuality. You know, maybe in the email the preceptor sent you, it will say the rotation time is, for example, eight until 430 but think about it, you know, account for all these possible delays, possible mishap time, but also that if you're a new student on rotation, and you may take a little longer time to work up your patients, you may need to arrive a little bit early. So just because the rotation time says eight to 430 kind of judge your ability to work up the patient, be ready for the rounds, be ready to answer your preceptor questions, and if you need to use the computer, fill out the charts on your clipboard before the rounds time you may need to add one or two hour extra on top of the required time you have to be there. Dr. Sean Kane 08:18 And just think about that, both from a patient care standpoint, and also the perception of professionalism. So for patient care, the more time you have, the better care you're going to take your patients, and two, from your preceptors point of view, if you're getting there way earlier than you need to in order to be successful, your evaluations are going to reflect that, because you're clearly demonstrating a desire to be professional and a desire to improve patient care. Speaker 1 08:41 Absolutely. I mean, I still remember my inpatient rotation. You know, it seemed like my preceptor, quote, unquote, rolled in late, but he was on time. We just needed to be early, because, as students, it took us a while to get the patient workup, get the sheets ready and make sure we are up to date with the lab results and ready to participate in the rounds, Dr. Sean Kane 09:01 absolutely and unfortunately, sometimes you are going to be late, whether it's a train, an accident, weather, whatever it is, if you are going to be late and you know it, and you can safely phone call your preceptor, you really should do that. So as soon as you know you're going to be late, if you can safely use your phone, you should be calling your preceptor or emailing your preceptor, depending on what that conversation has been like in advance to tell them that you're going to be late. And I'll tell you that when we have winter storms and many employees are late when that student is on time, that's an extra check mark in my book of awesomeness for that student, that despite that weather, they plan for it in advance and knew that they would need extra time. And that's awesome. Absolutely. Speaker 1 09:42 Another way to show that you're ready for your rotation is to be resourceful. So kind of gather the resources, right? So that's our point. Three, is resources. And I've always told us to the student, that you know a good pharmacist is not know it all pharmacist, but a good pharmacist is a. Resourceful pharmacist who knows where to go and to look up the information accurately, Dr. Sean Kane 10:05 whether you're on the inpatient side or the outpatient side. There's going to be some topics that are going to come up time and time and time again. These are things like heart failure, COPD asthma, hypertension, diabetes, coronary artery disease. These topics are absolutely so common, it's in your interest to have algorithms, flow charts, whatever you need to have, maybe reviewing those book chapters, having the book chapters with you electronically, whatever it is, you know that these are going to come up so commonly, so you have those resources readily available, so that you can be a superstar when it comes to seeing the ninth or 10th patient of the day that has those comorbidities, Speaker 1 10:41 absolutely, you know, I would even suggest going to the point where, you know, if you want to have it on your electronic laptop or tablet, those PDFs. But if not, you know, print those algorithms create like a folder to carry with you, so you can easily refer those things, another thing to kind of create. And it comes in really handy, even for the trained pharmacist or residents even carry these things in their pocket. It's like a quick pocket guide that contains common lab values, looking at the unit conversions, math equations that you can easily refer to, pull it up and then do your calculations or conversions. Dr. Sean Kane 11:17 So when I was a resident, I had basically a small photo album that you could put note cards in at this point. I don't use it as much, but I have kind of a very small notepad that I'll write down things that I just can't remember for the life of me. So it could be a hydrocortisone to prednisone conversion. It could be, how do you convert from one ACE inhibitor to a different ACE inhibitor? Things that commonly come up on my rotation I'll write in that book as a reference to myself. But if you're a student, you don't really know what those things may be. So these peripheral brains kind of populating them and organizing them, that's really important to help you be an efficient pharmacy student and eventually a pharmacist as well. Speaker 1 11:55 That's an excellent example. Dr. Kane, you and I didn't talk while we were APPE students, but I also had a photo album that I got ready and kind of customized it as to what I needed for my rotation. Dr. Sean Kane 12:05 That's awesome. Well, in thinking about that, number four is being proactive, and thinking about your peripheral brain, or that kind of pocket guide that you have that would be considered being proactive on your rotation, knowing that things are going to come up, and getting ready and having those resources ready. Being proactive isn't just about having these resources, but it's also about thinking ahead. So if you know that your patient has hypertension, and you think your preceptor might ask you, what is the goal blood pressure for this patient? You look it up in advance. So even if you didn't know it cold, you've looked it up. You're ready for your preceptor. You're ready for that Q and A that you have, or even ready for the patient when they walk in and ask you questions about some of their new medications, right? Speaker 1 12:43 I think a common thing is for students to feel is that, oh, my preceptor just kind of threw me into this education session where we were starting a new medication on the patient, and I needed to go and talk to the patient about, you know, discharge counseling. But if you if you heard and paid attention during the rounds where the talk was, hey, we're going to add this medication on the discharge list. You know, as a student, an example of being proactive would be you sitting there looking up, what are the counseling points? Because guess what? The job is coming to me. Dr. Sean Kane 13:12 And commonly, what I see in terms of very low hanging fruit for being proactive is in the ICU, where we recommend antibiotic therapy. So it's not enough to just say I want to give this patient cefepime. Being proactive would be actually figuring out what dose Do you want to give them based on their renal function or based on the indication, so thinking the whole way through, because nothing looks worse than you say, I recommend cefepime for this patient. And they say, Okay, what dose? And then you're pulling out your phone or looking it up and looking unorganized. So even if you don't know the dose offhand, look it up, be proactive before you make that recommendation, because you're probably going to get follow up questions about Speaker 1 13:49 your recommendations, right? And there should be a complete regimen recommendation, right? So not only dose that's renally or hepatically appropriate, but then looking at what would be the duration of therapy, right? What would be any kind of monitoring if we need to do as a team, Dr. Sean Kane 14:02 absolutely so. In thinking of other aspects of being proactive, the APPE syllabus or an APPE handbook from your preceptor or from your college, that's going to have a lot of really useful information in terms of what you should be reviewing in advance of that rotation. What are common topics that come up? Speaker 1 14:19 Yeah, it will have information about different projects that you'll be responsible for doing on the rotation the evaluation criteria for these projects as well. So when you're making those projects, you will know what important things to include and guidelines to abide by, because that's what your preceptor is going to hold you true for. Dr. Sean Kane 14:36 And you're also going to see things like goals inside the syllabus or the handbook. So what are you supposed to get out of that rotation? And if you think about it, if you're kind of residency bound, you want your preceptor to give you an excellent recommendation, a rec letter for residency applications, or you just want to get a really high quality experience out of your APPE rotation, you really should be telling your preceptor. In advance. Hey, I'm really interested in residency. What can we do for my personal goals, or for the goals of the rotation, to really target things that might be related to residency down the road? Speaker 1 15:10 I think that's a really important example, because you know, the preceptor knowing that the student wants to do residency may push them a little bit harder, maybe design special activities for them, or even their institutions have residents, then maybe the students could be paired up with the residents to do some shadowing activities. Another kind of activity that brings proactiveness is feedback. It's usually the norm that rotation will provide two different feedbacks midpoint and, you know, the final evaluation, that's more of a formal evaluation. But let's say you're unsure about your task. Let's say you educated a patient about Warfarin on a discharge counseling, but you're not really sure if how you performed, if you missed out any points or not, because that was your first direct patient care rotation. Ask your preceptor, you know, ask for these frequent performance feedbacks, and that will show that you want to better your performance, and that therefore you're asking these frequent feedbacks. Dr. Sean Kane 16:11 And if you go back to an episode with Professor winickie, just a couple episodes ago, we talked about how even pharmacists need to have this skill where, if they aren't sure of their performance, that they're actively asking for that feedback. They're being proactive with it. The same is true with students. Yes, students get a little bit more feedback than an actual hired pharmacist, but students, if you need more feedback, you have to ask for it. It's not always going to be handed to you. Speaker 1 16:34 Absolutely. Preceptors, as you know, they're not only assigned to students, they have patient care, they have managerial responsibilities and stuff, so lot of things are going on. You just have to ask for some time on the side. Dr. Sean Kane 16:47 And then one of my pet peeves is when I listen to a presentation and a student says, I'll get back to you. And then they never get back to that preceptor who asks the question. So again, as part of being proactive is that you take the initiative to write down questions that you receive that you promise to have follow up on, you actually do that follow up that's so important. It really shows professionalism. It shows a dedication to patient care, and it shows that you're proactive enough that you take that initiative. So if you get those questions, absolutely follow up on those right? Speaker 1 17:16 And then sometimes you know that pharmacist who asked you the question may not interact with you in the next few days. So it's not like you have to go hunt down that pharmacist in order to give the answer, but ask for their email address or, you know, email id or phone number, and then you can always reach out to them and say, Hey, this is what I found, or this is the answer I have for you. Dr. Sean Kane 17:36 And it should be intuitive, but it's one of those things that it may not be if that wasn't your primary preceptor who asked the question, and you choose to email whoever asked you the question, cc your primary preceptor because that shows them that you did the follow up. It shows them that you did this work, and you get credit for it by copying your preceptor onto that email. If you don't do that, your preceptor may not know that you actually did the follow up, and you're you're missing out on this really good opportunity to show this dedication to patient care. Speaker 1 18:05 Absolutely I still have to this day. You know, whenever I listen as a main preceptor or even as an adjunct preceptor, I write down the questions that I've asked students, and as a preceptor, I keep track of how many answers I get back, because that shows the integrity that shows the patient care follow up, the DI aspect of the rotation itself. Dr. Sean Kane 18:25 Dr. Patel, I'm going to be really honest with you, usually I pretend that I don't remember the questions that I ask, but I usually do, and I typically write them down. And the reason is that I'm assessing the students ability to be proactive with that, and I don't want them to know that I'm always remembering the questions that I ask, because I want them to show that they took that initiative Absolutely. So number five, we have to talk about this. And this could be its own HelixTalk episode on its own, but presentations, specifically presentations where you're giving PowerPoint presentations or a journal club or something like that, there are some very key elements and key tips that we can give in a very short time period in this episode related to higher quality presentations from students. Speaker 1 19:08 Yeah. So first and foremost, know your subject in itself, get it approved by your preceptor ahead of time. Usually, you know being proactive includes discussing these projects at a time, clarifying any expectations. What will be the format? Who would be your audience? So you can tailor your presentation to them accordingly. What kind of tools will be available to you? So is it? Is there going to be a projector? Is there going to be a slide advancer? Is there going to be enough time for Q and A? You need to think about all those aspects so you can design the presentation accordingly. Dr. Sean Kane 19:40 Dr. Patel, I'll tell you that the most common reason that I have a discrepancy in my expectations in the actual presentation is that the student didn't really adequately talk to me about the topic to kind of get a feel for what I wanted to get out of it versus what they thought I wanted to get out of it. And commonly, what happens is they kind of. Go off in the wrong direction. They'll pick the wrong articles that aren't really relevant to that topic, where they just have some misconception about the topic. And I think a lot of that can be addressed with a 15 minute conversation about the topic with your preceptor to understand what they don't understand about the topic, what they want to get out of it, what are some key points that they want you to cover? All of that could be easily accomplished in that 10 to 15 minute conversation with the preceptor, Speaker 1 20:24 absolutely, especially when these presentations are going to be presented in more of an in a professional environment, and this is more of the pharmacy's teaching opportunity to, let's say nursing community, or even physician community, then we need to know that we're presenting the most up to date information, most relevant information. Dr. Sean Kane 20:42 So in terms of the actual presentation itself, the number one tip I have is do not read your slides or your handout. And again, this seems so intuitive, but it is absolutely so common that I'll sit down, I'll see 60 slides from a student, and they read verbatim every single bullet point. I do not want to sit through that presentation. I want to hear what you as the student have to say about the topic, not what your slides say. Speaker 1 21:07 And another thing is to kind of use the AMA style, although the 10th manual of the AMA referencing style doesn't include information about how to exactly reference your slides, but it's always important to put abbreviated references at the bottom of each slide, rather than having more excited or reference you know slide at the end, because we don't know where your information on that particular slide comes Dr. Sean Kane 21:31 from, and especially if your preceptor is well versed in the topic that you're presenting on, for the most part, I'm going to know your references. And if they're not at the bottom, then I don't know where you're getting your information from, and if you do include them at the bottom, it helps me understand what you got out of whatever article that you're citing in that particular slide. Speaker 1 21:51 And my biggest pet peeve is when I see students citing lecture notes or their PowerPoints from the professors that they've learned those lectures from. Do you ever wonder where your professors bring this information from? Right? They either bring it from your tertiary or primary, most likely primary literature and review articles and book chapters. So make sure you go to the source itself, and not the lecture that was developed using those sources. I think Dr. Sean Kane 22:17 you have to recall that those lecture materials are educational materials provided by your faculty members. Things change. We've already had, you know, multiple updates to hypertension guidelines, for example. So things change. But also, those slides are meant not to be a reference, but to teach you about the topic, right? So you need to be using more reference oriented materials, like primary literature when you create your slides. If you're giving a more scientific topic as opposed to a more educational topic. So the last tip about presentations is to practice. And a very common scenario I see is that students are way over or way under on their time. And for the most part, as long as you have the quality that you need, being under on your time is okay, but if you're way over on your time, or worst case scenario, you have to be cut off because you're taking too much time out of the day. That's a problem. So make sure that you practice so that you know your material really well, but also you know your timing really well. To know is this the right amount of time that I have been allocated so that you're respectful of everyone's time in Speaker 1 23:16 the room, and this is where you can partner it up with the fellow epi students. You know, you can listen to their presentation, you can give your presentation in front of them. You can critique each other's presentation and get feedback and improve together. I think another important thing for students to keep in mind is to get their projects ready the day before the presentation, and there are a couple of reasons to do that is that then you don't have tendency to keep changing and adding things to last minute. Secondly, if there is a large amount of audience and paper copies need to be printed, your preceptor, or if you're in charge of going to the media, you know, office and getting those printed, you have enough time to do so, because when you have presentation in the day, that's not the only thing you're going to have. You're going to have you're going to get see your patient, you're gonna go on your rounds and stuff. Your preceptor is going to be busy, so don't expect that you will submit the PDF or the file 15 minutes before the presentation, and the copies will be magically ready for you. Dr. Sean Kane 24:12 Dr. Patel, I'm glad you mentioned that, because another common thing I see on my APPE rotation, I do a lot of projects because I think there's a lot of value in those projects. Very commonly, I see students that try to make these changes the morning of when they're supposed to be taking care of patients, not taking care of their presentation. And again, it seems intuitive that you're there to take care of patients. Those projects are things that need to be taken care of outside of the rotation. Preceptors know when you aren't taking good care of your patients because you're prioritizing your presentation, as opposed to the patient. So don't do that. Get it done the night before. That morning should not be spent managing your PowerPoint slides and things like that. Speaker 1 24:49 Yep, and lately, that's been part of the instruction, the clear instruction that I provide to the students, saying I need your presentation either the morning before you walk in that day or the night before the present. Presentation, because the exact reason you mentioned, I don't want them to be looking over their slides and prepping their slides rather than taking care of patients. Absolutely. Dr. Sean Kane 25:09 So number six, in terms of our tips for being successful in your APPE rotations, is to be engaged in your rotation. Dr. Patel, what does this mean to you? Speaker 1 25:16 Well, being engaged in the rotation is actively learning, right? And when I think student is actively learning is when they're asking a lot of questions about the patient care. The more questions we ask, the better it is. But they shouldn't be questions that you can easily look up using a drug information resource, for example. So what dose of cephalexin would you give to this patient who had a UTI? No, your Preceptors are more likely is going to tell you, Well, why don't you look it up? Right? So that kind of ties along with that being proactive, instead of asking that question, be ready with the answer. But the questions you can ask your preceptor is, you know, in guidelines or in school, this is how we learned. But what do you normally see in practice, how would you go about and treating this patient? Or how would you pick between, for example, a pioglitazone versus Metformin for this patient? Absolutely. Dr. Sean Kane 26:11 And to tag along to that, it could be questions like, I read this article and I don't understand XYZ. So showing that you've done the work, you've done the thing that they're gonna that is kind of the baseline knowledge, and you're still not there, and you're using your preceptor as a resource to help more fully understand the topic, right? Speaker 1 26:29 And then sometimes you know your nature might be that you're an introvert, that you're timid, that you're shy, and therefore you're not asking a whole lot of questions. But be careful, because your preceptors and the fellow pharmacists in the pharmacy may not know this, and you may come across as rather not interested in the rotation or patient care altogether. And I Dr. Sean Kane 26:50 think that this is a very common misconception that being introverted is bad. That's absolutely not the case. Introverts can still ask questions. They can still engage in the rotation. Being introverted or extroverted doesn't necessarily mean that you can't engage and you can't ask questions of your preceptor. The way that you ask questions may be different, the time that you ask them may be different, but its core every student, regardless of your introvertedness, should be asking questions to better engage in the material of the rotation. Speaker 1 27:19 Yeah, and you're going to have to be the judge of when it's the appropriate time to ask questions. Your Preceptors are always going to be busy, right, doing one thing or another, jumping from one task to another. You just have to either in the beginning of the rotation, identify a time, maybe at the beginning of the day, or at the lunch time, or the, you know, end of the rotation when you're almost done with all patient care activity, that's when you ask questions about projects, about patients, about follow up questions on your patient case presentations, etc. Dr. Sean Kane 27:51 Segue into number seven, which is taking great notes. Part of that might involve that you're taking notes on the questions that you have so very commonly on rounds, at least in my practice site. It's really not the time for me to have Q and A with the student, because I'm trying to listen to the nurse and engage in a conversation with the ICU team. But I always tell the students, take good notes on rounds about any questions that you have, and I'm happy to answer them at the end of rounds. So taking good notes on questions that you have, but also taking good notes means that you're writing down things that you're learning during the APPE rotation as well. Right? Speaker 1 28:24 You know, I tell the students on the first day of rotation, usually that I evaluate students from point A to point B, meaning, where were they on day one of their rotation, and where are they on day last day of their rotation? Have they learned something? Have they progressed? So for example, if you look something up, let's say blood pressure goal for a patient greater than 60 years of age, and then a same case or similar case comes up, and then two weeks later, you forget what the goal was. Did you really learn anything? Right? So make sure you are maintaining the knowledge or things that you have you have looked up and refer and review those notes regularly, Dr. Sean Kane 29:04 think about if you applied that same practice in school. So when you sit in on a lecture, it's not like you just magically remember everything and you never have to study again, right? You take notes, you review, you study, you quiz yourself. The same is true on a nap, your rotation when you're learning stuff, it's not enough to just take it in and say, Oh, that's really interesting. I'm glad I learned it. That day you should be writing it down and reviewing stuff that you're learning. Because I promise you, if you do this for five days, five days is all it takes, from the first day to the last day, writing down stuff that you learned, I promise you, on that fifth day, you're going to look back and say, Wow, I totally forgot that. I'm glad I wrote it down now I'm going to remember it that much better. I think Speaker 1 29:42 that's a really good tip. That's a really good tip. So on the same note, let's say you and your preceptor sat down and you talked about a particular trial that was a landmark trial that you didn't know before, but the preceptor took time to, you know, go through the trial, explain you the results and therefore the impact in guidelines or patient. Care all together, then that tells you that, you know this is a really important resource. It may come across again, if not during the same rotation, maybe in future rotation. So your job as a student is to be a gatherer, right? Any kind of good information, new guidelines, good articles, good tricks and tips that come across. Save them, save them, print them, either save them electronically or keep them in your folder. Dr. Sean Kane 30:25 A great example of that would be commonly at Condell, where I work. I'll have students that are in a longitudinal APPE rotation. They may have spent time in the emergency department for six weeks, and then they come to me in the ICU for another six weeks. And nothing makes me smile more when I see a student who had an ED rotation. We talk about the NINDS trial, which was the alteplase for stroke trial. And as we start talking about it, they pull out the trial that they talked about in the ED and they have their highlighted notes on the trial, and they know everything about it because it's right in front of them. They saved it. They saw the value in that primary literature that is an excellent student, where they're using the resources that they've received from other rotations and applying it to the next rotation, applying it to patient care. That is absolutely outstanding, right? Speaker 1 31:10 And then think about it, you know, at the end of the day, we are providing patient care, but it's not expert opinion. We're looking at evidence based care, right? So when you're referring back to these primary articles in making important patient care decisions, you are employing that concept of evidence based patient care. Dr. Sean Kane 31:27 So Dr. Patel, what is number eight, our very last key point for being successful in APPE rotations? Speaker 1 31:33 And I think this kind of ties up the rotation or your interaction in a pharmacy world altogether. And I want to talk about civility. Kind of ties up to professionalism. You know, your professional, punctual, timely wise, your attire, your behavior wise. But this kind of ties up things like, just be respectful to every member of the organization. I'm talking about janitorial staff, to volunteers, to the director of the hospital, because guess what, you're being graded on every single of these interactions, even though your preceptor is not Dr. Sean Kane 32:06 around you, and to be honest with you, oftentimes, your preceptor may be asking for feedback from these other people that you don't know are actually providing that feedback back to your preceptor. So everyone is listening, everyone's taking notes, and not all of the time will go back to your preceptor, but you can be sure that if you do something bad, if you're not civil, if you are disrespectful, that absolutely will make its way back to the Preceptor no matter what. Right? Speaker 1 32:30 And we hear this all the time. Dr. Kane, pharmacy is a small world, right? So what I want to say here is make sure you don't close any doors. Make sure you don't burn any bridges. You want to keep all the doors and bridges open, because, hey, this APPE rotation could be an extended job interview or a residency interview. If you're going to apply for job or residency at the same institution, they're going to remember you that. Oh yes, that was an excellent APPE student. I think we should give him or her a chance Absolutely. Dr. Sean Kane 33:02 And I can tell you that this has happened at Condell and other sites in the area that I'm exposed to time and time again, where you'll have either really, really good or really, really bad, APPE student, and that dramatically paints your ability to be competitive for PGY one or a job down the road. We've hired excellent p4 students that we had on rotations, mostly because we had this great experience with them. We knew their skill set. We had the six week job interview with them, and they excelled at it. And for the most part, as a someone who's hiring a pharmacist, that six week experience is going to be dramatically more valuable than a CV and a letter of recommendation from a mystery person that you've never met before, Speaker 1 33:41 and I agree that's a firsthand encounter with the person they're supposed to hire for six weeks of time. So make sure you take this opportunity very seriously and that you're accounting for your responsibility and you're owning these patients. Right? Sometimes students have this mentality that they're going to be on the rotation for six weeks, and who cares what happens after, you know, I leave from here, and that's not the case. It really touches me, and I'm protective of my patients, right? So it really touches me when I have students on the rotation who take care of the patient just as much I would want them to with the integrity, the love, the respect, the desire, and obviously the clinical care. Dr. Sean Kane 34:26 I think a very easy litmus test is, if this was your mother, what would you want to do for that patient? Or if you as a student were taking care of your own mother, how would you be treating that patient? How would you be interacting? How would you be engaged in the process of taking care of that patient, I promise you, if it was your own mother, you wouldn't be working on your PowerPoint slides that morning instead of looking over their chart, right? And it's such a simple thing. It's so intuitive, but sometimes you have these conflicting interests in terms of your APPE grade and projects and things like that. But it comes down to patient care. That's why you're being a pharmacist, is to take. Excellent care of patients. Show it and own it as you are on your APPE rotation, and Speaker 1 35:05 think about it. You know, when it comes to your preceptor taking care of the patient, they have worked so hard to make that reputation of the team worker. You know they're working with the nurses, the doctors, the PT, the OT, and they have a certain sense of presence within a team, and you don't ever want to let your preceptor down because your actions weren't meeting these, you know, expectations. But at the same time, when you are putting yourself as a student in front of patients, you know, they're they're thinking, Oh, this was a pharmacy student, right? So at the end of the day, you are the face of the pharmacy, and whether you behave poorly or excellent in front of the patient is going to show the judgment of how the pharmacy or pharmacists, or future pharmacists, are going to provide that care for patients, absolutely. Dr. Sean Kane 35:57 And to kind of wrap things up, it's really interesting how your impression is a reflection of so many different aspects. So you mentioned of the pharmacy services at your site. It's also a reflection of you in terms of your ability to be hired in the future. It's a reflection of your preceptor who spent time to establish their clinical practice site. It's also a reflection of your college. Did they do a good job preparing you to be on that APPE rotation? So it's not just about you, it's about a number of different facets, and you are responsible for owning the image of all of those facets. As the APPE student, I think you put it down. Really excellent. Dr. Kane, well, I think that that wraps up HelixTalk episode 81 quite well. If you want to see a list of these eight ways to excel in your APPE rotation, check out HelixTalk.com we're also on Twitter. At HelixTalk. We don't ask a lot of our audience, but if you do have a moment, we would absolutely adore a five star review on iTunes. And if you wouldn't mind adding a comment of what you like about the podcast or what episodes you want to hear in the future, we read every single comment. We talk about it. We want to hear from you guys. So if you wouldn't mind take the two minutes to go on iTunes, leave that five star review and leave an excellent comment on what you love about the podcast. So with that, I'm Dr. Kane Speaker 1 37:08 and I'm Dr. Patel and study and APPE hard. Narrator - Dr. Abel 37:13 If you enjoyed the show, please help us climb the iTunes rankings for medical podcasts by giving us a five star review in the iTunes Store, search for HelixTalk and place your review there to Narrator - ? 37:24 suggest an episode or contact us. We're online at HelixTalk.com thank you for listening to this episode of HelixTalk. This is an educational production copyright Rosalind Franklin University of Medicine and Science.