Allison Field, PharmD candidate

We are 3 student pharmacists adapting to the opportunities and challenges of beginning Advanced Pharmacy Practice Experience (APPE) rotations during the coronavirus disease 2019 (COVID-19) pandemic, and never could have imagined we would be experiencing our long-anticipated P4 rotations during the worst public health crisis our country has seen in a century. It has been eye-opening to have a role in the treatment of critically ill patients and to observe developments regarding COVID-19 in real-time, but it has also included unforeseen challenges.

Student pharmacists across the country have had to adjust their expectations of what P4 year will look like. Many of our peers have not been allowed to attend medicine or elective rotations that aligned with their career goals, switching to any remaining preceptor able to take students, including drug information or evidence-based medicine rotations that occur solely in a virtual format. Although it may not be what these students had imagined, it is impressive how pharmacy schools have been able to adjust to help students to still have a beneficial, meaningful experience.

Luckily, we are able to attend our medicine rotation at a hospital, but there are a few caveats. Every morning, we must arrive early to have our temperature checked before entering, and we have to bring masks to wear the entire day. This interprofessional rotation is typically aligned with 3rd year medical students, but they will not be returning to rotations until mid-summer. We still round daily with the physicians, but we are not allowed in the rooms of patients who have been diagnosed with COVID-19, so we have had to develop treatment plans through nontraditional pathways.

Many unexpected challenges have arisen throughout our rotation, but we are doing our best to adapt to them. For example, we have observed how difficult the restrictions placed on visitation have been to patients, their families, and hospital staff. These restrictions have affected all hospital patients, not only those with COVID-19. The visitation restrictions have made it increasingly difficult for hospital staff to collect a patient’s medical and social history. Many older or extremely ill patients are poor historians, so the lack of having caretakers present creates a gap in the important background information needed to treat a patient. This gap includes a complete list of home medications, medication adherence, medication allergies, and awareness of all medical conditions. This has highlighted how important having a support system present is for hospitalized patients. Furthermore, without any visitors, the patients seem lonely when we go to talk to them. To adapt to this, we try to be more intentional with our patient interactions and engage in meaningful conversations since we are one of their few face-to-face interactions of the day.

Additional challenges include increased difficulty in communication due to the new personal protective equipment (PPE) requirements that COVID-19 demands. We have found that when talking with a patient or other health care provider, it is more difficult to be understood clearly when speaking from behind a mask—especially with older patients or those who are hard of hearing. It has also been more difficult to connect with patients since they cannot see our faces beneath the mask. PPE can interfere with our ability to express nonverbal communication cues, such as smiling, when trying to convey empathy. Another concern that we have had is that the PPE may cause increased patient anxiety, as it is a visible reminder of the pandemic. To alleviate this, we often directly address the issue by making a joke about the masks being a pain, and let them know we are smiling underneath, which sets them at ease.

Despite the challenges, we have grown both personally and professionally during this difficult time. We have identified several positive opportunities during our ongoing experience. This includes the chance to learn firsthand about the developing treatment options for a novel disease, and the importance of critically evaluating primary literature, including preprint articles. We also get to experience providing care to critically ill patients during a health crisis, which will prove invaluable to us in the event of future crises. The pandemic has allowed us to foster empathy for patients who are isolated, and for hospital staff who are operating in challenging and demanding conditions in order to provide the highest level of care.

We feel very fortunate to be able to attend our medicine rotation during these uncertain times, and to receive first-hand experience with treating COVID-19. During this time, we have identified many barriers to providing our professional service. However, as we reflect on our rotation, we feel thankful to have an opportunity to learn while also experiencing history being made. This pandemic is a once in a lifetime event, and we are extremely motivated to help patients in any way we can during this difficult time.

are 2021 PharmD Candidates at Harrison School of Pharmacy, Auburn University in Alabama.

Articles

Three student pharmacists share their experiences adapting to APPE rotations during the COVID-19 pandemic,