Role of Pharm.D students in hospital

This blog I am writing to help Pharm.D students while they are in hospitals. I have come across a general question that maximum Pharm.D students face during their hospital postings which is “What is the role of Pharm.D students in the hospital?”

Hospital postings in the Pharm.D are from the 2^nd year as per the course curriculum issued by the Pharmacy Council of India and the duration of hospital hours increase gradually with the increase in the academic years.

I would like to directly come over to the role and responsibilities of PharmD students in various hospital activities. In this post, it is assumed that every Pharm.D college is associated with a teaching hospital where MBBS or related medical postgraduate courses are running.

Following are the various Clinical Pharmacy activities that a Pharm.D student have to participate in while in their regular posting in the hospital:

1. Ward Round Participation in hospital
2. Attending OPD
3. Bedside Teaching
4. Case Presentation
5. Journal Club Meeting
6. Attending DIC (Drug Information Centre)
7. Reporting ADRs and understanding & implying Pharmacovigilance, Pharmacoeconomics and other related.

However, these are the terms you will hear from everyone but when you go to the hospital these activities seem worthless as you may not find them interesting or other issues that you might be facing further develops a lack of interest.

Let’s move forward step by step.

1. Ward Round Participation in hospital-

For the already admitted patients:

A. Preparing for Ward Round participation

• Instead of directly participating in ward rounds, it has been seen always beneficial to do homework. So, let’s move to the homework part.
• Get details of the patient present illness condition
• Investigate and correlate laboratory data with diagnosis and drugs dosage regimen and also the treatment protocol being followed.
• Once get confident of the patient’s condition and disease knowledge along with the treatment protocol, you are ready to attend ward rounds. (You may ask the patient for current condition and any new complaints)

B. Attending Ward Round

• After the homework, get ready to attend the next morning ward round.
• You’ll relate and enjoy, how the treatment pattern is sustaining or being changed after which complaint or by determining which values.
• Follow Dos and DON’Ts.
• It’ll generate interest in ward round participation and then you will be able to mark any objections if any and report or discuss the same.
• From the next follow up days for the same patients, ask questions about improvement in a way to make them frank for you. Some patients will start asking their doubts automatically regarding regimen& treatment from you too.

For reporting: Firstly, approach and discuss your findings with your seniors, if needed after that, then to faculty members. If the doubt is not cleared yet, then, you should approach Junior residents (JR) and discuss it. If JR is not there in your department, then approach Senior Residents (SR). And even If SR is not there, then only approach the consultant doctor.

For newly admitted patients:

A. Preparing for Ward Round participation

• Check for the OPD card to know about the reason for which the patient has been admitted.
• Check for the patient’s past medical history.
• Check what has been prescribed initially based on his complaints.
• Check for provisional diagnosis and make yourself updated about the condition and relate the advised lab investigations with the condition and then be prepared for the treatment options according to the lab values and the condition.

B. Attending Ward Round

• Attend ward round like before and do follow-ups as before.
• Follow Dos and Don’ts.

DOs and DON’Ts while participating in Ward Rounds:

1. Don’t start counselling of the patient initially, if you are not confident because if there have been any issues due to it to the hospital or doctor, you only have to be responsible and will get scolded.
2. Be polite while interacting (either it is patient or their attendant or any health care staff) as you are there to learn.
3. Ask for patients’ files when they are not in use by the nursing staff or other healthcare staff.
4. Manage your daily schedule for file study according to the working of healthcare staff in the ward.
5. Don’t ask for a patient’s file when any healthcare staff is using it.
6. Don’t go there at an odd time (like at midnight or early morning) so that the staff get anxious at you for no reason.
7. If the nursing staff refuses to give some files in the private ward, maybe they are confidential, try to understand.
8. If they constantly refuse to give general files (even when you ask them for an alternate time, as when the files will be free for you), report to your seniors, if seniors are not their go for your college faculty and HOD with your complaint.
9. Always follow the pattern while complaining/ asking for any issues, it will make your path easy in the hospital setting (as you also will never wish to get any extra issues or failure on your name).
10. Don’t create hindrance while ward round participation (like trying to get too close to consultant doctor or not making space for JRs and SRs or the attending nursing staff; as you too know that doctor will ask and explain things to Jr, SR more, as they are from their field and also, he knows what to explain them and don’t know about what to explain to Pharm.D (you).
11. Don’t directly ask any question or query to consultant while attending ward round ( If you get any time gap while going from one ward to next, firstly try to ask your question directly as brief as possible. Don’t be too regular or too irregular in asking and don’t behave something like to come in Doctor’s good book, you’ll instead ruin your image.). Ask relevant questions and let Doctor answer, and listen carefully.
12. Be regular and punctual.
13. If Doctor says you to study something, get your ass off the whole night if needed and study and be punctual.
14. Answer as much as the Doctor seemed to be interested in hearing.
15. Interact while answering- Don’t start giving a lecture over it.
16. Interact with the patient only if you are confident enough ( don’t create any issue for the hospital by your patient counselling.)
17. First, try to attend ward rounds with your seniors and get yourself one to one with the rules and roles & the way of working. As the way of working may slightly differ in different hospitals.
18. If you have done any mistake in the hospital while your activities, inform your seniors as soon as possible.
19. Don’t try to show off as you know everything (even if you know) or as if you are the consultant itself. Don’t try to prove him wrong based on your assumptions as you and your juniors have to learn from him even after that day& keep this too in mind that he has been practising the same from more than the years that you are studying Pharm.D.
20. Be polite and ask about your doubt and then discuss with your faculty.
21. Learn from your mistakes and improve yourself.
22. Don’t mess up the file while returning.
23. Try taking your homework round in the daytime or the evening (apart from bedside teaching).
24. Try to connect with JR, SR and make your time for learning with them(apart from bedside teaching).

2. Attending the OPD:

Dos and don’ts while Attending OPD –

1. When you are comfortable firstly ask your JR or SR for OPD attending ( If JR, SR not available then ask Doctor)
2. Don’t get over-excited or pressure your JR or SR or Doctor to allow you to sit in OPD if they are unwilling. In this case, they won’t teach you anything or it’ll become an awkward situation as they may intentionally ask you many questions and will prove that you are incompetent for this.
3. However, in this above condition, try to learn everything that they are asking (always remember, if someone bullies you by asking subject or profession-related questions, then, as much as you answer them, it will benefit you only.
4. Don’t try to create hindrance while clinical examinations or prescription writing
5. Instead of just going on time and sitting in OPD, just go before time and take the patient history and his/her current complaint, this will help you understand the treatment approach and how the medicines are being prescribed.
6. Learn how the patient is being counselled, what questions are asked to them, and how the prescribing of medicines is relating the complaints and provisional diagnosis.
7. Learn how patient history is obtained.
8. As the clinical examination is not our portion, try to concentrate on how the clinical examinations lead to certain lab tests and medication prescribing.
9. If you are not sitting in the OPD room,i.e, if you are sitting beside the OPD room and the Doctor sends the patient to let you explain the medicines and dose intervals.
10. Don’t get frustrated that you aren’t learning and it is all waste. Try to get benefits out of it – like you’ll be able to learn patient counselling (in a minimum time interval and effectively).

3. Bedside Teaching:

1. Follow the same steps and homework as the ward round participation.
2. Make discussions and lectures outside the ward as homework followed by more interactive sessions near to patients’ bedsides.
3. Get actively involved, which will result in more efficiency and frankness at the end.

4. Case Presentation:

1. Present your case according to the case presentation schedule. You’ll learn from others too and learn more from your case too. Hence, you will develop more interest in doing your hospital rounds.
2. Prepare your case, explain everything invite for open discussion.
3. Same way learn from others.

5. Attend Journal Club meetings

6. Attend DIC (Drug Information Centre):

1. Get involved in DIC activities.
2. Learn patient counselling
3. ADR reporting
4. Pharmacovigilance working
5. Working and functioning of DIC.

 

 

-Pharm.D 5th year student