Pharmacy Experiential Rotation Topic Discussions
Dates of Activities: 8/12/2020, 11/17/2020, 3/16/2021, 4/19/2021
Setting: Arkansas Children's Hospital Pharmacy Conference Room
Length: 3o minutes each
Description of Activity: I led four different topic discussions throughout my first year as a resident. The topics covered included congenital heart defects, extracorporeal membrane oxygenation, drug overdose, and pediatric advanced life support/rapid sequence intubation. These topic discussions were conducted while I had students on rotation in the cardiovascular intensive care unit during their fourth year and with third-year pharmacy students who were rounding in the pediatric intensive care unit during a pediatric elective course. We discussed guidelines, common practice variations, and how pharmacists play a role in each of the topics. I spent time throughout the week prior to the discussion (approximately 8 hours) preparing for the topic discussions. These discussions ranged from 30 minutes to 1 hour. These topic discussions occurred over several months throughout the 2020-2021 residency year.
Experience of Learners: Third and fourth-year pharmacy students
Comfort level: I felt a decent level of comfort during the experience because they were topics that I had previously discussed when I was first on rotation in those units. Each topic is a disease state or condition that is common in my practice, so discussing it was not out of the ordinary workflow. The difficulty that presented itself during the discussions was tailoring the information to students who had already been in acute care rotations vs those that were still completing their didactic curriculum.
Method of Teaching/Assessment: Prior to the topic discussions, I would ask the individual learners to explain to me everything that they knew about each of the topics. This provided a baseline level to which I could expand on or further explain. For many of these topics, the learner would have limited background knowledge which allowed for an appropriate amount of individual teaching. Following the discussion, I would ask the learner some follow-up questions to gauge the retention of the information that I just gave. I would then clear up any misconceptions. For many of the topic discussions, I utilized hands-on teaching. This included walking the learner through the entire extracorporeal membrane oxygenation circuit, drawing many of the congenital heart defects, and displaying the medications in a pediatric crash cart. For one learner, they explained that they learned better by reading the information, so I provided a handout on drug overdose (below) for them to read along as I explained the topic, as well.
Goals addressed:
Goal 2: Provide a variety of objective and quality written and verbal feedback to promote learner growth.
Goal 3: Implement adaptive teaching methods to promote knowledge retention and meet individual learning needs.
Reflection: Participating in topic discussions with individual learners was incredibly important to my growth as a teacher and my progress towards my teaching goals. Topic discussions were some of the first things that I led as a resident both on the individual and small group scale. The nature of being able to interact one on one with a learner allowed for greater adaptability. It was a goal of mine to be willing to and able to change my teaching methods even as rapidly as is required during a topic discussion to meet the individual learner's needs. I was able to achieve this by constantly asking follow-up questions regarding the information I had just shared with the learner and providing feedback on their retention while asking for feedback on how they were learning the information. This provided accountability for both their learning and my teaching throughout the discussion.
Materials: Medication Overdose Topic Discussion
Evaluations: Individual Topic Discussion Evaluations
Advanced Pharmacy Practice Experience
Date of Activity: January 2021
Setting: Arkansas Children's Hospital Cardiovascular Intensive Care Unit
Length of Activity: 1 month
Description of Activity: As a first-year resident, I had the opportunity to precept one fourth-year student by myself. This was during my second rotation in the cardiovascular intensive care unit. This meant that I had a greater level of comfort with the clinical aspects of the unit and was better prepared to take on the added responsibility of teaching a fourth-year student. This occurred in January of 2021. I spent the last week of December preparing the activities that would be completed during the rotation.
Experience of Learners: Fourth-year pharmacy student
Comfort level: I felt confident in my abilities clinically during this experience and knew that the information that I was giving them about the unit and the medicines used within it was likely to be correct. The area that I lacked confidence in was questioning whether or not I would be able to portray the complexities of a cardiovascular intensive care unit to a student who was only one year removed from the level of knowledge I had at the time.
Method of Teaching/Assessment: At the beginning of the rotation, I asked the learner what her career goals and aspirations were. This enabled me to tailor the overall rotation to what she needed to learn for the future, but I also made sure to include aspects of the rotation that were a necessary part of a pediatric cardiovascular rotation. The ultimate goal of this rotation was to advance the learner's knowledge and ability to complete entrustable professional activities.
Goals addressed:
Goal 1: Develop clear lecture objectives to effectively guide learners through the learning experience.
Goal 2: Provide a variety of objective and quality written and verbal feedback to promote learner growth.
Goal 3: Implement adaptive teaching methods to promote knowledge retention and meet individual learning needs.
Reflection: Honestly, having a student on rotation was such a joy for me as a teacher. I remembered valuing the preceptors who seemed to honestly care about me as a student more than any other preceptor and aimed to achieve that throughout the month-long rotation. I started the rotation out by asking the student what their interests were and what their career goals included before developing the syllabus or the calendar for the year. The syllabus is included in my selective experiences, but the calendar is included below. During the month the learner participated in two journal clubs and one case presentation while also providing written SOAP notes each week. As the month progressed I wanted the learner to gain confidence in themselves while also learning a lot of new information that their didactic curriculum may have never introduced to them. This meant that I taught them how to be a pharmacist on rounds, how to actively look up patient information and guideline-based therapy, and how to communicate with both providers and patients/caregivers. The learner at the midpoint expressed that they were excited about learning the information and wanted to be challenged more. This enabled me to change my teaching to try to provide more independence for the learner in the experience. This experience helped me grow as a teacher as the learner grew as a student pharmacist.
Materials: Student Schedule January 2021; Rotation Syllabus - CVICU
Evaluations: Rotation Evaluation - CVICU
Patient and Caregiver Counseling
Dates of Activities: 9/16/2020, 11/27/2020, 2/7/2021
Setting(s): Arkansas Children's Hospital Pediatric Intensive Care Unit and Cardiovascular Intensive Care Unit
Description of Activity: As a pharmacist, counseling patients is a major part of the everyday workflow, so it may be difficult to see this as a special kind of individual teaching. However, in my opinion, when the counseling is to a pediatric patient or their caregiver, the level of adaptiveness necessary and the ability to assess their understanding becomes very important. There are a few experiences that I believe tested me as a teacher with a variety of different learners. Patient and caregiver encounters occurred throughout the residency year of 2020-2021. I spent approximately 10 minutes preparing for each encounter.
Experience of Learners: Pediatric patients (age 11-17) and adult caregivers
Comfort level: It was difficult to always be confident prior to counseling patients. I felt the same way as a student when I was set to counsel someone during rotation. The reason I felt this way initially was that I knew that I was aware of the information that was pertinent and what I wanted to say, but I never knew the level of education and medical literacy that I was going to interact with. This meant that I especially needed to be on my toes and willing to adapt to the interaction.
Method of Teaching/Assessment: Teaching within these experiences ranged from discussing medications to exhibiting device techniques. I have spent as little time as 5 minutes counseling a caregiver to upwards of 45 minutes in a single counseling session about a medication list. In order to get an initial assessment of the patient or caregiver's knowledge of the medication, I would ask them to tell me a little bit about what they already knew. At the end of the encounter, I used teach-back techniques as well as asking if they had any additional concerns that I did not address.
Goals addressed:
Goal 3: Implement adaptive teaching methods to promote knowledge retention and meet individual learning needs.
Reflection: Three instances of patient counseling specifically stand out to me when I think back over this past year. First was a time when I was discussing discharge medications with a mother whose child was remaining in the hospital because she couldn't quite grasp the exact reason why and how her child was supposed to take their medication. I was able to sit down with the mother and discuss the medication at length and describe the syringe she was going to use, help her practice with it, and finally explain the importance of the medication. She was relieved to finally get a grasp on the medications so that they could get out of the hospital. Another great teaching example involved a patient that was hesitant to receive therapy because they did not fully understand the side effects but knew there were some possibly severe reactions after reading online. This was a unique experience because it involved a smart patient who had done the research and I had to tailor my teaching to provide a further increase in their background knowledge. It really challenged me to educate someone who was hesitant to accept the new information. Finally, my last eventful encounter involved the instruction of an Epi-Pen to a patient who was non-verbal. I initially started the encounter by instructing their caregiver on how to use the device, but after a few moments, it became obvious that the patient wanted to learn, as well. I definitely had to adapt my teaching methods to be able to explain a medication device to someone who could not communicate with me as well as other patients may have been able to.