Hello! My name is Kayla Wesley, Doctor of Pharmacy Class of 2024.
Interprofessional education is a component of the curriculum here at ACPHS. I also had the pleasure of participating on an interprofessional disciplinary team during my inpatient internal medicine rotation at Albany Medical Center.
As student pharmacists, we played an important role in elevating patient care via collaborative relationships with the medicine team. Our teams were varied with experience, consisting of the attending physician, medical residents, medical interns, and 3rd year medical students. The pharmacy half consisted of our clinical pharmacist preceptor Dr. Engle, PGY-2 pain and palliative care pharmacy resident Dr. Dean, and us P4 student pharmacists. Over the course of our 6 week rotation, the medicine team members rotated every couple of weeks, so we got to experience many different teaching styles and learned how to adapt our communication skills to fit each team.
Each week, us pharmacy students paired up with a new 3rd year medical student. Every day was different with new patients and follow-ups, but the days followed a similar workflow. During a typical day, us pharmacy students would arrive on the floor by 7AM each morning and chat with our respective medical students to see what new patients they had picked up. Some patients could have been admitted to the internal medicine floor from the emergency room, others could have been stepped down from the ICU, or some could have come from another hospital; each patient had a different story. As part of the pharmacy team, we would “work up” our assigned patients which meant consolidating their story to explain why they were here, what acute problems they had, and what medical interventions and medication changes we could do to help resolve those problems. This challenged us to apply the knowledge we had gained from our didactic coursework at ACPHS, and it was exciting to see how everything we have learned could be utilized in practice for real patients.
While working up our new patients, we also made time for reviewing our other patients from the days prior. By around 8:15, our preceptor Dr. Engle would arrive on the floor, and we would take turns presenting our newly admitted patients to her. We would run through the patient’s list of problems and our recommendations for them, whether it was a medication change, initiating or discontinuing a medication, obtaining new lab values to clarify the problem, and more. After solidifying our recommendations with our preceptor, we would find our medical students again and run through our patients together, listening to each other’s perspectives and thoughts, and make a plan for what we would present to the attending physician during rounds.
Most mornings we would also attempt to complete medication reconciliations as part of our patient work-up, which entailed obtaining a list of all the medications the patient takes at home and verifying via different resources it to ensure its accuracy. We would then update the home medication list in their chart so everyone on the care team could see, and then we would compare it with what the patient was receiving during their hospitalization. Medication reconciliations were another great intervention opportunity for student pharmacists to provide recommendations—we could ensure the patient receives the medications they usually take at home or recommend making adjustments to better optimize their regimens.
Rounds started at 9AM and everyone on the team would gather for patient presentations. The medical students would go first presenting their newly admitted patient, and us pharmacy students would chime in to go over the home medications and present our recommendations to develop an effective plan with the team. After presenting the newly admitted patients, everyone would present their follow-up patients from the days prior, and then review the patients being prepared for discharge. The total number of patients under our care varied each day, but was usually between 12-17, and rounds would last 2.5-3 hours. There were countless opportunities for teaching moments during rounds between the pharmacy members and the medicine members, and it was wonderful to see how powerful it really was to be able to share knowledge and gain insight from different clinical roles.
After rounds, our pharmacy team would touch base about what we needed to accomplish in the afternoon for follow-up, then we would head to lunch. Our afternoons had the greatest variability. After lunch, we would return to the floor and start working on any tasks and questions that were not answered during rounds. Follow-up could have consisted of doing pain assessments, doing detective work on medications, checking if certain labs had resulted yet, completing medication reconciliations, and more. We would pop back in to chat with the team about any further recommendations based on our afternoon follow-up and further solidify our plans.
Participating on an interprofessional disciplinary team helped me realize the value in my clinical role as a student pharmacist. By effectively contributing our services to improving patient care and letting no detail go unmissed, we could tangibly feel the trust and respect grow between our team members. It was genuinely a rewarding experience to see the value of our contributions on patient care.